Should We Transplant Candidates With a Positive SARS-CoV-2 RT-PCR Test?

Agnès Duveau, Hannah Kaminski, Lionel Couzi, Inna Mohamadou, Florent Von Tokarski, Claire Tinel, Paolo Malvezzi, Baptiste Michard, Christophe Masset, Nathan Kasriel, Ilies Benotmane, Fanny Lebossé, Jérôme Dumortier, Filomena Conti, Nicolas Bouvier, Florence Lacaille, Nassim Kamar, Mehdi Maanaoui, Dany Anglicheau, José Ursic-Bedoya, Marie-Noëlle Hilleret, Marie Matignon, Coralie Poulain, Sophie Caillard, Adrien Flahault, Ilias Kounis, Baptiste Giguet, Léonard Golbin

Journal: Transplantation 2025;109(7):1257-1260

PMID: 39883018

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Abstract

BACKGROUND

It remains unclear whether physicians should accept transplantation offers for candidates with a positive SARS-CoV-2 reverse transcription polymerase chain reaction test due to the potential risk of severe infection after initiating immunosuppressive therapy.

METHODS

A multicenter observational study was conducted in 19 French solid organ transplantation units. Patients on the waiting list for liver or kidney transplants who had a positive SARS-CoV-2 reverse transcription polymerase chain reaction nasopharyngeal swab at the time of transplantation were recorded.

RESULTS

Sixty-five patients were included. The recipients were predominantly men (n = 40; 62%) with a mean age of 55.4 y (SD = 16.5). On the day of transplantation, 2 patients exhibited symptoms compatible with COVID-19. The majority of patients (n = 55; 85%) underwent thoracic imaging, with only 3 patients showing imaging results compatible with COVID-19. Ten patients (28%) had a cycle threshold value <30. Anti-SARS-CoV-2 spike protein serology within 3 mo before transplantation was available for 36 patients; only 2 patients were seronegative. Due to COVID-19, physicians adapted the immunosuppressive therapy for 16 patients (25%). Specific antiviral therapy was used for 15 patients (23%), primarily remdesivir (n = 12). Overall, the majority of patients did not receive any adjustment of immunosuppressive therapy or antiviral treatment (n = 36; 55%). The outcomes were generally favorable even for patients with the lowest cycle threshold values, indicating a high viral load. Four patients died during follow-up, although none of these deaths were attributable to COVID-19.

CONCLUSIONS

Transplantation appears to be safe for patients who are asymptomatic or have mild symptoms, reassuring thoracic imaging, and a history of anti-SARS-CoV-2 infection and/or immunization.

Address: Department of Nephrology Dialysis and Transplantation, Strasbourg University Hospital, INSERM U1109, Strasbourg, France.; Department of Nephrology Dialysis, Transplantation and Apheresis, Bordeaux Pellegrin University Hospital, Bordeaux, France.; Institut de Transplantation-Urologie-Néphrologie, Nantes University Hospital, Nantes, France.; Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Strasbourg University Hospital, Strasbourg, France.; Department of Nephrology, University of Grenoble, Grenoble, France.; Department of Hepatology, CHU Pontchaillou, Rennes, France.; Department of Nephrology and Transplantation, University of Dijon, Dijon, France.; Department of Medical Liver Transplantation, Hôpital Pitié-Salpétrière, APHP, Paris, France.; Department of Nephrology, Dialysis, and Transplantation, Foch Hospital, Suresnes, France.; Department of Hepatogastroenterology, Hepatology and Liver Transplantation Unit, Montpellier University Hospital, Montpellier, France.; Université Paris Est Creteil, INSERM IMRB U955, AP-HP, Groupe hospitalo-universitaire Chenevier Mondor, Nephrology and Renal Transplantation Department, Fédération Hospitalo-Universitaire "Innovative Therapy for Immune Disorders", Créteil, France.; Department of Nephrology, University of Lorraine, CHRU-Nancy, Vandoeuvre, France.; Kidney Transplantation Department, Pitié-Salpêtrière University Hospital, APHP, Paris, France.; Hepatology Department, Croix Rousse Hospital, Lyon Liver Institute, Hospices Civils of Lyon - Cancer Research Center of Lyon INSERM 1052 - Lyon 1 University, Lyon, France.; Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France.; Department of Nephrology and Transplantation, University of Lille, Lille, France.; Transplantation Hépatique, Centre Hépato-Biliaire, Hôpital Paul Brousse, APHP, Villejuif, France.; Department of Nephrology and Transplantation, University of Amiens, Amiens, France.; Hepatology and Gastroenterology Department, University Hospital Grenoble-Alpes, Grenoble, France.; Department of Nephrology and Transplantation, Necker University Hospital-Assistance Publique Hôpitaux de Paris, Paris, France.; Gastroenterology-Hepatology-Nutrition Unit, Necker University Hospital-Assistance Publique Hôpitaux de Paris, Paris, France.; Department of Nephrology and Transplantation, University of Caen, Caen, France.; Department of Nephrology and Transplantation, University of Rennes, Rennes, France.; Department of Nephrology and Transplantation, University of Angers, Angers, France.; Department of Hepatogastroenterology, Edouard Herriot University Hospital, University Lyon-1, Lyon, France.

DOI: 10.1097/TP.0000000000005333

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MeSH Terms: Humans, Male, Middle Aged, Female, COVID-19, Kidney Transplantation, Adult, Aged, SARS-CoV-2, Liver Transplantation, Immunosuppressive Agents, France, COVID-19 Nucleic Acid Testing, Waiting Lists, Antiviral Agents