Return to School for Pediatric Solid Organ Transplant Recipients in the United States During the Coronavirus Disease 2019 Pandemic: Expert Opinion on Key Considerations and Best Practices

Downes, Kevin J.; Danziger‐Isakov, Lara; Cousino, Melissa K.; Green, Michael; Michaels, Marian G.; Muller, William J.; Orscheln, Rachel C.; Sharma, Tanvi; Statler, Victoria A.; Wattier, Rachel L.; Ardura, Monica I.

doi:10.1093/jpids/piaa095

Cited by 18 publications

(20 citation statements)

References 48 publications

(56 reference statements)

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“…8 Recent guidelines on return to school for paediatric transplant recipients highlight the lack of published data. 19 Our analyses do not show any significant difference in the severity of COVID-19, based on dialysis status, underlying kidney condition or number of immunosupressant medications.…”

Section: Discussioncontrasting

confidence: 49%

COVID-19 in children treated with immunosuppressive medication for kidney diseases

et al. 2020

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BackgroundChildren are recognised as at lower risk of severe COVID-19 compared with adults, but the impact of immunosuppression is yet to be determined. This study aims to describe the clinical course of COVID-19 in children with kidney disease taking immunosuppressive medication and to assess disease severity.MethodsCross-sectional study hosted by the European Rare Kidney Disease Reference Network and supported by the European, Asian and International paediatric nephrology societies. Anonymised data were submitted online for any child (age <20 years) with COVID-19 taking immunosuppressive medication for a kidney condition. Study recruited for 16 weeks from 15 March 2020 to 05 July 2020. The primary outcome was severity of COVID-19.Results113 children were reported in this study from 30 different countries. Median age: 13 years (49% male). Main underlying reasons for immunosuppressive therapy: kidney transplant (47%), nephrotic syndrome (27%), systemic lupus erythematosus (10%). Immunosuppressive medications used include: glucocorticoids (76%), mycophenolate mofetil (MMF) (54%), tacrolimus/ciclosporine A (58%), rituximab/ofatumumab (11%). 78% required no respiratory support during COVID-19 illness, 5% required bi-level positive airway pressure or ventilation. Four children died; all deaths reported were from low-income countries with associated comorbidities. There was no significant difference in severity of COVID-19 based on gender, dialysis status, underlying kidney condition, and type or number of immunosuppressive medications.ConclusionsThis global study shows most children with a kidney disease taking immunosuppressive medication have mild disease with SARS-CoV-2 infection. We therefore suggest that children on immunosuppressive therapy should not be more strictly isolated than children who are not on immunosuppressive therapy.

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Section: Discussioncontrasting

confidence: 49%

COVID-19 in children treated with immunosuppressive medication for kidney diseases

et al. 2020

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“…Although limited by reporting bias, our data supports that SARS-CoV2 infection in children with LD or LT is different than adults with less morbidity and associated mortality. Continued meticulous attention to primary preventive measures, counseling and family support, particularly with return to school challenges, is, however, paramount ( 46 ). Further data collection is required to permit the large-scale analyses essential to inform optimal immunosuppression management and disease-specific treatments for pediatric LD and LT patients.…”

Section: Discussionmentioning

confidence: 99%

Severe Acute Respiratory Syndrome Coronavirus‐2 Infection in Children With Liver Transplant and Native Liver Disease

Kehar

Ebel

et al. 2021

J. pediatr. gastroenterol. nutr.

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Objective: Increased mortality risk because of severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) infection in adults with native liver disease (LD) and liver transplant (LT) is associated with advanced age and comorbid conditions. We aim to report outcomes for children with LD and LT enrolled in the NASPGHAN/SPLIT SARS-CoV2 registry. Methods: In this multicenter observational cohort study, we collected data from 91 patients <21 years (LD 44, LT 47) with laboratory-confirmed SARS-CoV2 infection between April 21 and September 17, 2020. Results: Patients with LD were more likely to require admission (70% vs 43% LT, P = 0.007) and pediatric intensive care unit (PICU) management (32% vs 4% LT, P = 0.001). Seven LD patients required mechanical ventilation (MV) and 2 patients died; no patients in the LT cohort died or required MV. Four LD patients presented in pediatric acute liver failure (PALF), 2 with concurrent multisystem inflammatory syndrome in children (MIS-C); all recovered without LT. Two LD patients had MIS-C alone and 1 patient died. Bivariable logistic-regression analysis found that patients with nonalcoholic fatty LD (NAFLD) (odds ratio [OR] 5.6, P = 0.02) and LD (OR 6.1, P = 0.01, vs LT) had higher odds of severe disease (PICU, vasopressor support, MV, renal replacement therapy or death). Conclusions: Although not directly comparable, LT recipients had lower odds of severe SARS-CoV2 infection (vs LD), despite immunosuppression burden. NAFLD patients reported to the registry had higher odds of severe SARS-CoV2 disease. Future controlled studies are needed to evaluate effective treatments and further stratify LD and LT patients with SARS-CoV2 infection.

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“…Considering that children are likely to be less contagious than adults [13,14], the burden of the school closure and confinement on their life [3,15] and that data about a possible spike in SARS-CoV-2 cases during school reopening are contrasting [16], the costeffectiveness of this measure should be carefully pondered by policy makers.…”

Section: Discussionmentioning

confidence: 99%

Frequency of asymptomatic carriers of SARS-CoV-2 among children and adults after school reopening

et al. 2021

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Background Children often develop an asymptomatic form of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but it is debated if children are at higher risk than adults to be asymptomatic carriers of SARS-CoV-2, especially during the school reopening. The main aim of this study was to investigate the frequency of SARS-CoV-2 asymptomatic carriers in children and adults during the reopening of the schools in Milan, Italy. Methods We conducted a cross-sectional study at the pediatric and adult Emergency Department (ED) of the Ca' Granda Ospedale Maggiore Policlinico (Milan) between October 1 and 31, 2020, i.e. 3 weeks after the reopening of schools. Patients admitted to the ED short stay observation and without any sign or symptom consistent with a SARS-CoV-2 were eligible. These patients underwent a nasopharyngeal swab specimen for the detection of SARS-CoV-2. The odds ratio and its 95% confidence interval (CI) was calculated to assess the risk of asymptomatically carrying the SARS-CoV-2 infection in children and adults. Results A total of 69 (27 females, median age 8.7 years) children and 251 (107 females, median age 71 years) adults were enrolled. Pediatric and adult subjects tested positive for SARS-CoV-2 with a similar frequency (1/69 [1.4%] vs 4/251 [1.6%]). Children had an odds ratio to be a carrier of 0.91 (CI 0.02– 9.38) compared to adults. Conclusions The frequency of asymptomatic SARS-CoV-2 carriers was similar among children and adults. Considering the emerging diffusion of new SARS-CoV-2 variants, the asymptomatic spread of SARS-CoV-2 infection among children and adults should be monitored.

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Return to School for Pediatric Solid Organ Transplant Recipients in the United States During the Coronavirus Disease 2019 Pandemic: Expert Opinion on Key Considerations and Best Practices

Cited by 18 publications

References 48 publications

COVID-19 in children treated with immunosuppressive medication for kidney diseases

COVID-19 in children treated with immunosuppressive medication for kidney diseases

Severe Acute Respiratory Syndrome Coronavirus‐2 Infection in Children With Liver Transplant and Native Liver Disease

Frequency of asymptomatic carriers of SARS-CoV-2 among children and adults after school reopening

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