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Outcomes and Complications of COVID-19 in Pediatric Solid Organ Transplant Patients
Leah Ott1, Pamela N. Scalise2, Brendan Kimball1, Mari Nakamura1, Khashayar Vakili1, Heung Bae Kim1, Alex Cuenca1
1Boston Children's Hospital, Boston, Massachusetts, United States, 2Boston Children’s Hospital Department of Surgery, Boston, Massachusetts, United States

1. Objective. Limited data are available on COVID-19 in pediatric solid organ transplant (SOT) patients. The purpose of the study was to examine the clinical course, outcomes, and complications of COVID-19 in a multi-organ cohort from one institution.

2. Design. Retrospective case-control study.

3. Setting. One tertiary children's hospital.

4. Patients. SOT patients up to 21 years old diagnosed with COVID-19 from March 2021 to December 2021. This cohort was compared with age-, sex-, and ethnicity-matched controls with COVID-19, but no history of SOT.

5. Interventions. None.

6. Main Outcome Measures. Outcome measures including hospital admission, hospital length of stay, ICU admission, ICU length of stay, and treatment. Complications including thrombotic complications, multisystem inflammatory syndrome in children (MIS-C), new transplant organ rejection, and death.

7. Results. 55 SOT patients with COVID-19 met study inclusion criteria. Ten patients were excluded from analysis due to insufficient documentation of COVID-19 diagnosis or course. The SOT cohort was composed of 18 kidney, 17 heart, six liver, two lung, one liver-kidney, and one multivisceral transplant patients. Median age at COVID-19 diagnosis was 13 years (interquartile range (IQR) 9.5) for the SOT group, and 13 years (IQR 10.0) for the control group (p = 0.96). Median time from transplant to COVID diagnosis was 2.6 years (IQR 4.2). Of the 45 SOT patients, 19 were white non-Hispanic/Latino (42.2%), 13 were white Hispanic/Latino (28.9%), six were Black (13.3%), two were Asian (4.4%), three were other (6.7%), and two were unknown (4.4%). 23 patients (51.1%) were male.

Compared to the control group, the SOT group had higher rates of comorbidities, including hypertension (35.6%), diabetes mellitus (8.9%), chronic kidney disease (11.1%), and other causes of immunodeficiency (11.1%). In the SOT group, 13 patients were asymptomatic (28.9%), compared to six patients in the control group (13.3%) (p = 0.071). Hospital (13.3% versus 15.6%, p = 0.764) and ICU admission rates (4.4% versus 6.7%, p > 0.999) were comparable between the SOT and control groups. The majority of patients in both the SOT (82.2%) and control (80.0%) groups received supportive care in the outpatient setting (p = 0.788). There was one case of MIS-C in the SOT group (2.2%) versus three in the control group (6.7%) (p = 0.616). One SOT patient developed COVID-associated microangiopathy (2.2%), but there were no thrombotic complications among controls (p > 0.999). There were no new cases of cellular or antibody-mediated rejection following COVID-19. There was one death in the SOT cohort from COVID-19.

8. Conclusions. We report the largest cohort of pediatric solid organ transplant recipients with COVID-19 to date. Our findings suggest pediatric solid organ transplant patients fare similarly to healthy children, without elevated risk of severe disease or complications from COVID-19.


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