Clinical Outcomes and Antibody Response in COVID-19–Positive Pediatric Solid Organ Transplant Recipients

Talgam-Horshi, Efrat; Mozer‐Glassberg, Yael; Waisbourd‐Zinman, Orith; Ashkenazi‐Hoffnung, Liat; Haskin, Orly; Levi, Sharon; Hamdani, Gilad; Landau, Daniel; Alfandary, Hadas

doi:10.1097/inf.0000000000003293

Cited by 13 publications

(7 citation statements)

References 9 publications

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“…As for pediatric solid organ transplant (SOT) recipients, Talgam-Horshi et al revealed a 96% seroconversion rate among 25 patients. However, they did not present the antibody levels or compare them with a control group [14]. Meanwhile, researchers from Saudi Arabia observed eight pediatric kidney transplant (PKT) recipients and showed their ability to maintain detectable levels of antibodies at a median follow-up time of 75 days [15].…”

Section: Discussionmentioning

confidence: 99%

Immune response to SARS-CoV-2 infections in children with secondary immunodeficiencies

Kuczborska

Krzemińska²,

Buda³

et al. 2022

Preprint

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Background and PurposeIt is a matter of research, whether children with immunodeficiencies are able to generate an effective immune response to prevent SARS-CoV-2 reinfection. This study aimed to evaluate and compare the seroconversion rates and cellular immunity to COVID-19 in immunocompetent children and those with secondary immunodeficiencies. MethodsIn 55 children — 28 immunocompromised and 27 immunocompetent — hospitalized with confirmed SARS-CoV-2 infection, the level of IgG antibodies against the Spike protein was determined on two to three occasions. In those children from the study group, whose immunosuppressive treatment did not alter during the study (n=13) and in selected children from the control group (n=11), flow-cytometric evaluation of lymphocyte subsets was performed twice — two weeks and three months post-infection. ResultsSeroconversion reached 96.3% in both studied groups, however, the immunocompromised cohort achieved lower titers of detectable anti-S antibodies. There was no correlation between seroconversion or titers of antibodies and the total number of lymphocytes or their subsets. In the immunocompetent cohort, we reported a significant decrease in NK cells during the infection. In this group and the entire study population, a positive correlation was noticed between the CD4+/CD8+ T cell ratio and the severity of COVID-19 pneumonia. ConclusionsChildren with secondary immunodeficiencies seroconvert in equal percentages but with a significantly lower titer of anti-S antibodies compared to their immunocompetent peers. Lower number of NK cells in the immunocompetent cohort may result from their participation in antiviral immunity. Whereas reduced CD4+/CD8+ T cell ratios among immunocompromised children can be a protective factor against a severe COVID-19.

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Section: Discussionmentioning

confidence: 99%

Immune response to SARS-CoV-2 infections in children with secondary immunodeficiencies

Kuczborska

Krzemińska²,

Buda³

et al. 2022

Preprint

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“…We report increased immunosuppression burden during the last 2 years of the study period, even though no formal change to the protocol was made. This trend of increased immunosuppression burden to improve allograft survival will have to be balanced with the increased risk for infections in pediatric patients, especially during the era of COVID‐19 infection and its implications on pediatric transplant recipients 31 …”

Section: Discussionmentioning

confidence: 99%

“…This trend of increased immunosuppression burden to improve allograft survival will have to be balanced with the increased risk for infections in pediatric patients, especially during the era of COVID-19 infection and its implications on pediatric transplant recipients. 31 In conclusion, in this retrospective study, we analyzed the frequency, risk factors, and outcomes of viremias in pediatric kidney transplant patients. We found an increasing incidence of viremias in more recent years.…”

Section: Discussionmentioning

confidence: 99%

EBV, CMV, and BK viral infections in pediatric kidney transplantation: Frequency, risk factors, treatment, and outcomes

Levi

Davidovits

Alfandari

et al. 2021

Pediatric Transplantation

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Background Improved short‐ and long‐term outcomes of kidney transplantation have been achieved over the past decades due to improved immunosuppression. This may have increased the risk for infections and, particularly, for the viral infections: cytomegalovirus (CMV), Epstein‐Barr virus (EBV), and polyoma BK virus (BKV). Methods A retrospective review of viremic CMV, EBV, and BKV infections in pediatric renal transplant recipients treated and followed by a national referral center over a 10‐year period. Results Sixty‐seven patients (68% males) received 68 kidney grafts (62% from living donors) during the study period; the mean follow‐up period was 5.2 ± 2.4 years. Twenty‐seven viremic episodes were documented (CMV: 13, EBV: 6, BKV: 8) in 24 patients (35.2%). The median time (interquartile range) to viremia post‐transplant was 11 (4–38) months. The viral infection rate was significantly higher in the years 2014–2015 than in previous years (61% vs. 29%, p = .017). Compared to patients who did not develop viremia, patients with viremias were younger at the time of transplantation, were more likely to receive thymoglobulin induction pre‐transplant and to develop an acute rejection. Multiple logistic regression modeling identified transplant year and recipient's age as significant risk factors for viremia. Graft outcome and eGFR at the last follow‐up was similar between patients who did and did not develop viremia. Conclusions Viral infections continue to be a major cause of morbidity in pediatric kidney transplant recipients. However, with close monitoring and prompt intervention, patient and renal outcomes remain favorable.

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“…Most pediatric SOT cohorts reported hospitalization in 15-25% of patients with only a minority (1-7%) needing ICU-level care and only a handful of deaths attributed to COVID-19. 15 , 28 , 29 , 30 , 31 , 32 , 33 These cohorts principally included patients identified during the first waves of infection. The more recent Delta and Omicron variants have had greater impact on children.…”

Section: Introduction On Covid-19mentioning

confidence: 99%

“…To date the published literature on use of remdesivir, glucocorticoids and monoclonal antibodies for COVID-19 is limited to a case report of two pediatric SOT recipients hospitalized with COVID-19 who recovered after treatment with dexamethasone. 29 Several organizations including the National Institutes of Health have developed evidence-based guidance documents for prevention and treatment of COVID-19. 26 Based on these guidance documents and the reported epidemiology in SOT to date, organizations such as the Society for Pediatric Liver Transplantation and the American Society of Transplantation (AST), have extrapolated therapy recommendations to SOT recipients including the use of antivirals, glucocorticoids and monoclonal antibody preparations as locally available.…”

Section: Introduction On Covid-19mentioning

confidence: 99%

The impact of COVID-19 on the pediatric solid organ transplant population

Feldman¹,

Danziger‐Isakov²

2022

Seminars in Pediatric Surgery

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Clinical Outcomes and Antibody Response in COVID-19–Positive Pediatric Solid Organ Transplant Recipients

Cited by 13 publications

References 9 publications

Immune response to SARS-CoV-2 infections in children with secondary immunodeficiencies

Immune response to SARS-CoV-2 infections in children with secondary immunodeficiencies

EBV, CMV, and BK viral infections in pediatric kidney transplantation: Frequency, risk factors, treatment, and outcomes

The impact of COVID-19 on the pediatric solid organ transplant population

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