Cycle Thresholds Among Solid Organ Transplant Recipients Testing Positive for SARS-CoV-2.

Theodore, Deborah A; Greendyke, William G; Miko, Benjamin; Whittier, Susan; Green, Daniel A; Shoucri, Sherif; Verna, Elizabeth C; Zucker, Jason; Sobieszczyk, Magdalena E; Aaron, Justin G; Scully, Brian E; Saiman, Lisa; Pereira, Marcus; Furuya, E Yoko

BACKGROUND The optimal duration of Transmission-Based Precautions among immunocompromised patients with SARS-CoV-2 is unknown. METHODS Retrospective review of patients with solid organ transplant with positive SARS-CoV-2 PCR result from nasopharyngeal specimens admitted to the hospital between 3/13/2020 and 5/15/2020. RESULTS Twenty-one percent of solid organ transplant recipients with positive SARS-CoV-2 PCR detected ≥ 20 days after symptom onset (or after first positive test among asymptomatic individuals) had a low cycle threshold (i.e. high viral load). The majority of these patients were asymptomatic or symptomatically improved. CONCLUSIONS Solid organ transplant recipients may have prolonged high viral burden of SARS-CoV-2. Further data are needed to understand whether cycle threshold data can help inform strategies for prevention of healthcare-associated transmission of SARS-CoV-2 and for appropriate discontinuation of Transmission-Based Precautions.