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COVID-Positive Donor Organs Safe; Shorter Omicron Infectious Period?

25 Mar 2022 9:07 AM | Anonymous

The use of abdominal organs from COVID-19-positive donors for transplant was safe, a small study showed. [MedPage Today Molly Walker]

No rejection occurred among four recipients who received liver, kidney, or pancreas transplants from four COVID-positive donors, and none of the recipients acquired a COVID infection, reported Emily Eichenberger, MD, of Duke University in Durham, North Carolina, at a special COVID-focused pre-meeting of the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID).

"While limited, our experience to date supports the use of abdominal organs from COVID-19 positive donors as safe and effective, even those actively infected, or with lung disease caused by COVID-19," Eichenberger said in a statement.

In the protocol implemented by her medical center, organ type, duration and severity of COVID, signs of hypercoagulable illness, and quality of organs were taken into account, as was the urgency of the transplant.

She explained that transplants were allowed from COVID-positive donors, provided the organs were good quality, though lung and intestine transplants had to go through more enhanced criteria, such as whether the donor tested positive for COVID fewer than 20 days prior to death. This was consistent with CDC infection control practices, she noted.

Among the four recipients examined, a total of six abdominal organ transplants were performed. Of the donors, one died from COVID complications, including pulmonary emboli, one died from a brain abscess likely triggered by COVID infection, and the other two had "mild to moderate" infection and died of other causes (a stroke and a drug overdose). Two donors were unvaccinated, while two had unknown vaccination status.

At a median follow-up of 46 days, all six organs had stable graft function. One heart-liver transplant recipient required an "urgent heart re-transplantation," Eichenberger said, which was completed using an asymptomatic COVID-positive donor.

She noted that her medical center has performed 20 successful abdominal organ transplants in total.

Jury Still Out on Omicron Infectious Period?

In another presentation at this special ECCMID pre-conference on COVID, a researcher argued that there is not enough evidence to say definitively that the Omicron variant has a shorter infectious period than other variants.

Using samples of culturable virus as a proxy for infectiousness, research has yet to prove that the period of infectiousness for Omicron is shorter, said Marjolein Irwin-Knoester, MD, of University Medical Center Groningen in The Netherlands.

She pointed to diverging recommendations for isolation following exposure across countries, ranging from 4 days in Norway and Denmark, up to 10 days in Germany and France. Ten days is the isolation period recommended by the WHO, she added.

"The decisions being made by different countries around the world to shorten the period of isolation for Omicron infections are partly based on evidence from modeling, but also take account of the fact that Omicron is causing less severe disease, and fewer hospitalizations and deaths," Irwin-Knoester noted. "From the evidence so far, I am not convinced that a person is likely to be infectious for a shorter period of time with Omicron as they would have been with previous variants."

She recommended an isolation period of 7 days, with 5 days as an "acceptable balance" between risk of infectiousness and what communities are likely to tolerate, but pointed out that this does not apply to everyone. Immunocompromised patients, especially transplant recipients and hematology patients, can shed infectious virus for months, and in that case, cycle threshold values should be used. Those with "continuing airway symptoms" like coughing and sneezing should also likely isolate for up to 10 to 14 days, she advised.

Molly Walker

 is deputy managing editor and covers infectious diseases for MedPage Today. 

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