The value of point-of-care tests for the detection of SARS-CoV-2 RNA or antigen in bronchoalveolar lavage fluid

As SARS-CoV-2 primarily resides in the respiratory tract, lung transplant recipients have been a highly vulnerable patient group during the COVID-19 pandemic (Vanlerberghe et al., 2023). A challenging scenario is donor-derived transmission of SARS-CoV-2 despite a negative reverse transcription quantitative PCR (RT-qPCR) result on upper respiratory tract (URT) samples (Mahmood et al., 2021). There are several reports of SARS-CoV-2 transmission during lung transplantation (LTx) that led to COVID-19 in the recipient (Van Slambrouck et al., 2022, Querrey et al., 2021, Ushiro et al., 2021). LTx recipients require profound immunosuppression, which increases the chance of a severe course of disease in COVID-19 including a fatal outcome. Missed detection of SARS-CoV-2 in deceased donors has resulted in severe and fatal COVID-19 after LTx (Kaul et al., 2021, Kumar et al., 2021). A potential strategy to intercept viral presence in donor lungs is the use of portable point-of-care tests (POCTs) that enable rapid detection of SARS-CoV-2 RNA or antigen in bronchoalveolar lavage (BAL) fluid samples obtained at the moment of procurement (Van Slambrouck et al., 2022). However, data on the value of POCTs for this purpose are scarce (De Pace et al., 2021, Dinnes et al., 2022, Schildgen et al., 2021, Wolters et al., 2020). The aim was to determine the value of three commercially available POCTs for the detection of SARS-CoV-2 RNA or antigen in BAL fluid samples: cobas Liat, ID NOW and Rapid Antigen Test (RAT).

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