Using SARS-CoV-2-Positive Donors Under 1 Year of Age: A Case Series of Successful Combined Liver-Pancreas and Isolated Liver Pediatric Transplantation.

BACKGROUND: The rates of organ transplantation declined during the COVID-19 pandemic as donors testing positive for SARS-CoV-2 on respiratory PCR were ineligible to donate. The implications of this practice are important for patients with limited donor pools, such as pediatric populations. Several case studies have demonstrated non-inferior outcomes in adult patients receiving non-pulmonary organ transplants from COVID-positive adult donors. The feasibility and safety of such a transplant have yet to be established for donors under 1 year of age.

CASE PRESENTATION: We present two cases of non-pulmonary, solid organ transplantation from donors under 1 year of age testing positive for COVID-19 on respiratory PCR in the absence of respiratory or systemic symptoms. The first patient was a 15-month-old with Wolcott-Rallison Syndrome presenting with congenital diabetes and recurrent hepatitis. The patient underwent a combined liver-pancreas transplant from an 8-month-old donor. Postoperatively, the recipient did not have any complications related to COVID-19 but experienced a self-limited, transient respiratory distress. The second patient was a 5-month-old with methylmalonic acidemia experiencing recurrent metabolic crisis. The patient received a liver transplant from a 3-month-old donor. Immediate postoperative imaging revealed anastomotic thrombosis of the hepatic artery managed with arterial reconstruction.

CONCLUSION: Our case series is the first to establish the feasibility of non-pulmonary solid organ transplants from a COVID-positive donor under 1 year of age. This is also the first report of a successful combined liver-pancreas transplant from an infant donor. Transplantation from donors with a positive SARS-CoV-2 test may be feasible with adequate serologic testing and postoperative management.