The pediatric solid organ transplant experience with COVID‐19: An initial multi‐center, multi‐organ case series

Abstract

Background The clinical course of COVID‐19 in pediatric solid organ transplant recipients remains ambiguous. Though preliminary experiences with adult transplant recipients have been published, literature centered on the pediatric population is limited. We herein report a multi‐center, multi‐organ cohort analysis of COVID‐19 positive transplant recipients ≤ 18 years at time of transplant. Methods Data were collected via institutions’ respective electronic medical record systems. Local review boards approved this cross‐institutional study. Results Among 5 transplant centers, 26 patients (62% male) were reviewed with a median age of 8 years. 6 were heart recipients, 8 kidney, 10 liver, and 2 lung. Presenting symptoms included cough (n=12 (46%)), fever (n=9 (35%)), dry/sore throat (n=3 (12%)), rhinorrhea (n=3 (12%)), anosmia (n=2 (8%)), chest pain (n=2 (8%)), diarrhea (n=2 (8%)), dyspnea (n=1 (4%)), and headache (n=1 (4%)). Six patients (23%) were asymptomatic. No patient required supplemental oxygen, intubation, or ECMO. Eight patients (31%) were hospitalized at time of diagnosis, 3 of whom were already admitted for unrelated problems. Post‐transplant immunosuppression was reduced for only 2 patients (8%). All symptomatic patients recovered within 7 days. Conclusions Our multi‐institutional experience suggests the prognoses of pediatric transplant recipients infected with COVID‐19 may mirror those of immunocompetent children, with infrequent hospitalization and minimal treatment, if any, required.

The Trilogy of SARS-CoV-2 in Pediatrics (Part 1): Acute COVID-19 in Special Populations

“…20,21 A recent multicenter, multiorgan cohort analysis in pediatric solid organ transplant patients reported full recovery of all patients within 7 days and none required supplemental oxygen. 22 These findings mirror various other results suggesting milder symptomatology and better outcomes in children than adults, even in the presence of high-risk conditions. However, these results are limited by small sample size, and more robust studies are required before conclusions are made.…”

Impact of COVID-19 in solid organ transplant recipients

“…Intubation portended poor outcome with 40%–100% of ventilated patients dying in small cohorts 71,92 . Interestingly, according to a series of 26 pediatric SOT recipients, children did not suffer significant morbidity, with none requiring oxygen support and all recovering within 7 days, mirroring the less severe course described in immunocompetent pediatric patients 106 . Many studies have addressed risk factors for mortality with older age, 17,73,74,77,86,89,95,105 underlying cardiovascular or lung disease, 17,77,95 increased inflammatory markers 73,77,89 and lymphopenia 17,73 most commonly associated with increased mortality.…”

Heterogeneous Recommendations for School Attendance in Children With Chronic Kidney Diseases During the COVID-19 Pandemic in Europe

“…While the risk of a severe course of COVID-19 is markedly increased in adults with CKD ( 3 , 4 ) recent evidence on children with CKD or under immunosuppression is encouraging and points toward a milder course in this population ( 5 – 8 ). However, among reported severe cases and deaths in children with COVID-19, preexisting comorbidities are a frequent finding ( 1 , 9 ).…”

“…This is mostly in line with the excellent guidance provided by the Royal College of Pediatrics and Child Health and the British Academy of Pediatric Nephrology ( Table 2 ). Of note, these recommendations are cautious as there is still is no clear evidence that even these children are at a higher risk and most of the data is derived from adult studies ( 5 – 9 ). However, if followed consequently this should allow the majority of children with kidney disease to attend school even in times when general shielding is advised.…”