COVID-19 in pediatric kidney transplantation: The Improving Renal Outcomes Collaborative

Abstract

There are limited data on the impact of COVID‐19 in children with a kidney transplant (KT). We conducted a prospective cohort study through the Improving Renal Outcomes Collaborative (IROC) to collect clinical outcome data about COVID‐19 in pediatric KT patients. Twenty‐two IROC centers that care for 2732 patients submitted testing and outcomes data for 281 patients tested for SARS‐CoV‐2 by PCR. Testing indications included symptoms and/or potential exposures to COVID‐19 ( N = 134, 47.7%) and/or testing per hospital policy ( N = 154, 54.8%). Overall, 24 (8.5%) patients tested positive, of which 15 (63%) were symptomatic. Of the COVID‐19‐positive patients, 16 were managed as outpatients, six received non‐ICU inpatient care and two were admitted to the ICU. There were no episodes of respiratory failure, allograft loss, or death associated with COVID‐19. To estimate incidence, subanalysis was performed for 13 centers that care for 1686 patients that submitted all negative and positive COVID‐19 results. Of the 229 tested patients at these 13 centers, 10 (5 asymptomatic) patients tested positive, yielding an overall incidence of 0.6% and an incidence among tested patients of 4.4%. Pediatric KT patients in the United States had a low estimated incidence of COVID‐19 disease and excellent short‐term outcomes.

COVID-19 in children and young adults with kidney disease: risk factors, clinical features and serological response

“…However, testing for the virus was not widely performed in this cohort and only three patients had a positive PCR test [13]. Another study which included 24 patients identified from 22 centers in the USA, demonstrated an overall incidence of COVID-19 of 0.6% in pediatric KTRs [14]. Other studies were not able to estimate the incidence of COVID-19 in pediatric kidney disease, due to under-reporting of milder cases and asymptomatic patients who never presented to healthcare units [15].…”

“…One multicenter study reported eight pediatric KTRs with COVID-19, all of whom had mild disease although two were hospitalized [19]. Another multicenter study identified 24 pediatric KTRs with COVID-19, eight were hospitalized and two were admitted to the ICU [14]. A study from 30 countries described 113 pediatric KTRs and children on immunosuppressive medication for kidney disease who were diagnosed with COVID-19 [15].…”

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

“…The disease incidence among our pediatric SOT patients was considerably higher than the incidence previously reported among pediatric kidney recipients. 6 This difference may be due to the high population density and family crowding in certain Israeli cities and communities. During the acute phase of COVID-19 infection, 23 (92%) of our patients were symptomatic.…”

De novo collapsing glomerulopathy in a pediatric kidney transplant recipient with COVID‐19 infection

“…Two patients in that cohort experienced transient acute kidney injury and another two patients had biopsy confirmed acute rejection, and were treated per institutional protocols without reduction of immunosuppression. 15 In our case, due to the symptomatic COVID-19 infection with desaturations, concern for pneumonia, and severe allograft dysfunction, we opted for an overall reduction of immunosuppression by withholding mycophenolate mofetil and postponing active antibody-mediated rejection treatment other than intravenous immunoglobulin, along with systemic anti-inflammatory with intravenous methylprednisolone. This proved effective in preserving allograft function and reversing the acute nephrosis.…”