Donor to recipient transmission of SARS-CoV-2 by lung transplantation despite negative donor upper respiratory tract testing
Donor to recipient transmission of SARS-CoV-2 by lung transplantation despite negative donor upper respiratory tract testing
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DOI：
10.1111/ajt.16532
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发表时间：
2021-03-15
影响因子：
8.8
通讯作者：
Lauring, Adam S.
中科院分区：
文献类型：
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作者：
Kaul, Daniel R.;Valesano, Andrew L.;Lauring, Adam S.
我们描述了一例已证实的SARS-CoV-2从肺供体传播到受者的病例。捐献者没有感染SARS-CoV-2的临床病史或发现，对48小时内采集的鼻咽拭子进行逆转录聚合酶链式反应(RT-PCR)检测呈阴性。未进行下呼吸道检查。受者在移植后第3天(PTD)出现发热、低血压和肺浸润，在NP拭子样本上的SARS-CoV-2 RT-PCR检测为无反应，但在支气管肺泡灌洗液(BAL)中呈阳性。一位在移植过程中在场的胸科医生患上了新冠肺炎。对供者BAL液(在采购时获得)、接受者和受感染的胸科医生的分离株进行的序列分析证明，接受者和卫生保健工作者(HCW)感染来自供者。没有从这位捐赠者那里获得其他器官。移植中心和器官采购组织应对来自潜在肺捐赠者的下呼吸道样本进行SARS-CoV-2检测，并考虑为参与肺获取和移植的卫生工作者提供更好的个人防护装备。
We describe a case of proven transmission of SARS-CoV-2 from lung donor to recipient. The donor had no clinical history or findings suggestive of infection with SARS-CoV-2 and tested negative by reverse transcriptase polymerase chain reaction (RT-PCR) on a nasopharyngeal (NP) swab obtained within 48 h of procurement. Lower respiratory tract testing was not performed. The recipient developed fever, hypotension, and pulmonary infiltrates on posttransplant day (PTD) 3, and RT-PCR testing for SARS-CoV-2 on an NP swab specimen was non-reactive, but positive on bronchoalveolar lavage (BAL) fluid. One thoracic surgeon present during the transplantation procedure developed COVID-19. Sequence analysis of isolates from donor BAL fluid (obtained at procurement), the recipient, and the infected thoracic surgeon proved donor origin of recipient and health-care worker (HCW) infection. No other organs were procured from this donor. Transplant centers and organ procurement organizations should perform SARS-CoV-2 testing of lower respiratory tract specimens from potential lung donors, and consider enhanced personal protective equipment for HCWs involved in lung procurement and transplantation.