A new chapter in an evolving pandemic: Successful pediatric liver transplantation with SARS-CoV-2+donors

• Authors: Matthew Benjamin Goss, University of Texas Health Science Center; Daniel Hao Bin Leung, Baylor College of Medicine; Stephanie Pouch, Emory University; Flor M Munoz, Baylor College of Medicine; Elizabeth Andrea Moulton, Baylor College of Medicine; Tyler Malcolm Mccann Lambing, Baylor College of Medicine; Sarah Koohmaraie, Texas Childrens Hosp; Nicolas Fernando Moreno, Univ Texas Hlth Sci Ctr Houston; Christine A O'Mahony, Baylor College of Medicine; John A Goss, Baylor College of Medicine; Thao Nguyen Galván Nhu, Baylor College of Medicine
• Journal Title: PEDIATRIC TRANSPLANTATION
• Volume: Volume 26, Number 8
• Publisher: WILEY | 2022-10-04, Pages e14407-e14407
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1111/petr.14407
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Pediatrics; Transplantation; COVID-19; donor pool expansion; pediatric liver transplantation; SARS-CoV-2; SARS-CoV-2+organ donation; viral transmission; INFECTION

Abstract

Background: Amid a viral pandemic with poorly understood transmissibility and pathogenicity in the pediatric patient, we report the first pediatric liver transplants utilizing allografts from SARS-CoV-2+ donors. Methods: We describe the outcomes of two pediatric liver transplant recipients who received organs from SARS-CoV-2 nucleic acid test-positive (NAT+) donors. Data were obtained through the respective electronic medical record system and UNet DonorNet platform. Results: The first donor was a 3-year-old boy succumbing to head trauma. One of four nasopharyngeal (NP) swabs and 1 of 3 bronchoalveolar lavage (BAL) NAT tests demonstrated SARS-CoV-2 infection before organ procurement. The second donor was a 16-month-old boy with cardiopulmonary arrest of unknown etiology. Three NAT tests (2 NP swab/1 BAL) prior to procurement failed to detect SARS-CoV-2. The diagnosis was made when the medical examiner repeated 2 NP swab NATs and an archive plasma NAT, all positive for SARS-CoV-2. Both 2-year-old recipients continue to do well 8 months post-transplant, with excellent graft function and no evidence of SARS-CoV-2 transmission. Conclusions: This is the first report to describe successful pediatric liver transplantation from SARS-CoV-2+ donors. These data reinforce the adult transplant experience and support the judicious use of SARS-CoV-2+ donors for liver transplantation in children. With SARS-CoV-2 becoming endemic, the concern for donor-derived viral transmission must now be weighed against the realized benefit of life-saving transplantation in the pediatric population as we continue to work toward donor pool maximization.