Comparison of clinical features and laboratory findings of coronavirus disease 2019 and influenza A and B infections in children: a single-center studyRunning title: Clinical and laboratory findings of pediatric COVID-19 versus influenza patients

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Introduction: Several studies suggest that chronic immunosuppressive treatment in pediatric liver transplant recipients may predispose to increased risk of acquiring SARS-CoV-19 infection, however, the severity of the infection and mortality rates remains unclear due to the lack of sufficient clinical data. Herein, we assessed the severity and clinical features following SARS-CoV-19 infection in our pediatric liver transplant recipient's cohort. Methods: We assessed total of 118 pediatric liver transplant recipients between 1-18 years of age who had been followed between 01 March 2019 to December 2021. Demographic data, clinical and laboratory features were obtained from electronic medical record as well as the state health record system. The information regarding the severity of the symptoms, duration of hospitalization, and outcomes of the infection were obtained by telephone inquiries. Patients with COVID-19 infection prior liver transplantation, unknown hospitalization status or unconfirmed SARS-CoV infection were excluded. The demographic, clinical and laboratory features of the patients were analysed descriptively. Results: A total of 16 out of 118 (13.5%) pediatric liver transplant recipients were diagnosed with COVID-19 infection. Eleven (68.8%) patients were male with a median age of 14.8 (interquartile range, 8-16) years. The main presenting symptoms were as follows; fever in 8 (50%), cough in 6 (37.5%), sore throat in 4 (25%), runny nose in 5 (31.3%), myalgia in 3 (18.8%), and abdominal pain in 2 (12.5%) patients. None of the patients exhibited respiratory failure, arthralgia, smell and taste loss, or diarrhea. Out of 16 COVID-19 patients, 6 (37.5%) had complete blood count, biochemistry tests and coagulation profile. Four of them exhibited leukopenia and mildly elevated C-reactive protein. One patient required computed tomography of thorax due to respiratory distress which revealed the ground-glass opacity and minimal pleural effusion. Only 3 out of 16 patients required hospitalization with a mean 2.67-days length of stay. Two out of 16 patients received favipiravir and two patients required antibiotics treatment due to suspected pneumonia. No SARS-CoV-19 infection associated intensive care admission or death were observed in our study. Nine out of 16 patients with SARS-CoV-19 were unvaccinated due to following reasons: 8 patients were younger than 12 years as vaccination is not recommended in this age group by the current guidelines of the Turkish ministry of health, and 1 patient was recently tested positive for COVID-19 infection. Rest seven out of 16 patients had two doses of COVID-19 vaccination. Conclusion: In this study, pediatric LT patients with SARS-CoV-19 infection showed a wide range of clinical presentations while the outcomes of the infection were generally mild.

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