Evidence of SARS-CoV-2 Infection in Cells, Tissues and Organs and the Risk of Transmission Through Transplantation.

Gaussen, Amaury; Hornby, Laura; Rockl, Gary; O'Brien, Sheila; Delage, Gilles; Sapir-Pichhadze, Ruth; Drews, Steven J; Weiss, Matthew J; Lewin, Antoine

The emergence of the SARS-CoV-2 virus responsible for the COVID-19 pandemic has raised concerns for programs overseeing donation and transplantation of cells, tissues and organs (CTO) that this virus might be transmissible by transfusion or transplantation. Transplant recipients are considered particularly vulnerable to pathogens due to immunosuppression, and SARS-CoV-2 is likely to generate complications if contracted. Several signs and symptoms observed in COVID-19 positive patients reflect damage to multiple organs and tissues, raising the possibility of extra-pulmonary SARS-CoV-2 infections and risk of transmission. At the beginning of the pandemic, a consensus has emerged not to consider COVID-19 positive patients as potential living or deceased donors, resulting in a global decrease in transplantation procedures. Medical decision making at the time of organ allocation must consider safely alongside the survival advantages offered by transplantation. To address the risk of transmission by transplantation, this review summarizes the published cases of transplantation of cells or organs from donors infected with SARS-CoV-2 and assesses the current state of knowledge for the detection of this virus in different biological specimens, cells, tissues and organs. Evidence collected to date raises the possibility of SARS-CoV-2 infection and replication in some CTO, which makes it impossible to exclude transmission through transplantation. However, most studies focused on evaluating transmission under laboratory conditions with inconsistent findings, rendering the comparison of results difficult. Improved standardization of donors and CTO screening practices, along with a systematic follow-up of transplant recipients could facilitate the assessment of SARS-CoV-2 transmission risk by transplantation. The supplemental file associated with this article will be found at http://links.lww.com/TP/C182.