key: cord-0915193-pqax8yh1
authors: Murad, Haris; Dubberke, Erik; Mattu, Munis; Parikh, Bijal; Wellen, Jason; Alhamad, Tarek
title: Repeat SARS‐CoV‐2 testing after recovery. Is a pretransplant PCR necessary?
date: 2021-02-18
journal: Am J Transplant
DOI: 10.1111/ajt.16506
sha: 02e6be08f5652d440553e63a9be4304a4c18059a
doc_id: 915193
cord_uid: pqax8yh1

The emergence of SARS-CoV-2 and the clinical syndrome of COVID19 resulted in a major decrease in transplant volumes during the first months of the pandemic followed by a change in practice, with strict screening and SARS-CoV-2 PCR testing prior to transplant. Protocols required a negative SARS-CoV-2 PCR prior to proceeding with transplantation. Many transplants were delayed nationwide due to persistent positive PCRs in asymptomatic patients, sometimes for months (1).

virus between 10 and 20 days after symptom onset has been documented in some patients with severe COVID-19 and immunocompromised patients. 5 Here we report a case of a 64-year-old white female with stage 5 chronic kidney disease secondary to Alport's syndrome. She works at a nursing home and tested positive for SARS-CoV-2 by the rapid qualitative antigen test (using the Sofia SARS antigen FIA kit) 24 h after developing body aches and fever. She never developed any respiratory symptoms and her fever subsided within 1 day without any specific therapy. Six weeks later, she was called for a deceased donor kidney transplant organ offer.

As part of our workup upon admission to the hospital, a nasopharyngeal specimen was collected for SARS-CoV-2 testing, which was positive. Cycle threshold (CT) values on the Roche cobas SARS-CoV-2 assay for the ORF1a/b and E gene targets were 35.5 and 30.3, respectively (for our laboratory a CT of <38 and <45 is considered positive for the respective gene targets). It has been shown that CT values >30 indicate low viral load. 6 Since she was asymptomatic for more than 6 weeks, negative chest X-ray, and had a high cycle threshold on PCR, we believe that this was a detection of residual SARS-CoV-2 RNA in the absence of active infectious viral particles. Given the assessment that active viral replication was unlikely, we proceeded with a kidney transplant with 3 mg/kg of thymoglobulin as induction.

After the procedure, the patient was placed in the regular transplant floor without COVID-19 restrictions. She has been maintained on triple immunosuppression therapy as per our standard protocol with prednisone, mycophenolate mofetil, and tacrolimus. Our trough goals have been 7-10 ng/ml for the first month, and 5-7 ng/ml since then.

She remains asymptomatic without any fever or signs of infections at Tarek Alhamad https://orcid.org/0000-0003-4289-0817

UNOS. COVID-19 Resources for Organ Transplants and Donations

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