Open AccessSARS‐CoV‐2 Infection in Pediatric Solid Organ Transplant Recipients
Author(s) -
Paul Saikat,
Royal Scott,
Lee Margaret,
Shin Stephanie,
Chahine Joeffrey,
Rozeboom Aaron,
Ahn Jaeil,
Dhani Harmeet,
Yazigi Nada,
Kaufman Stuart,
Khan Khalid,
Matsumoto Cal,
Kroemer Alexander,
Fishbein Thomas,
Ekong Udeme D.
Publication year - 2022
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000003548
Subject(s) - medicine , convalescence , asymptomatic , serology , gastroenterology , antibody , organ transplantation , medical record , immunology , transplantation
Objectives: This is a descriptive study to characterize rates of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection in pediatric solid organ transplant (SOT) recipients during the early days of the pandemic. We hypothesized that asymptomatic infection may represent a large proportion of SARS‐CoV‐2 infection in pediatric SOT recipients. Methods: We queried Organ Transplant Tracking Record (OTTR) for all pediatric SOT recipients followed at our center and reviewed medical records to identify patients tested for SARS‐CoV‐2 between March 15, 2020 and June 30, 2021. Patients were tested by polymerase chain reaction (PCR): prior to planned procedures or because of symptoms; OR: tested by measurement of IgG to spike protein with their routine labs q 2‐monthly. A positive PCR was called acute infection. A positive IgG with negative PCR was called convalescence. For immunologic studies, blood was obtained when the PCR or IgG was positive. Statistical comparisons were made between (1) acute infection versus convalescence; (2) acute infection versus SOT recipients without infection (called healthy controls); (3) liver transplant (LT) versus small bowel (SB)/multivisceral transplant (MVT); (4) positive versus negative test result. Results: Of 257 LT recipients, 99 were tested: 6 were PCR positive, 13 were antibody positive. Of 150 SB/MVT recipients, 55 were tested: 4 were PCR positive, 6 were antibody positive. Of 8 simultaneous liver, kidney transplant recipients, 3 were tested: 1 was PCR positive. Symptoms when present were mostly mild. Patients with a positive test result were younger (6.3 vs 10.0 years; P = 0.017). We observed a rapid decline in viral load within 96 hours without a change in immunosuppression. Antibody lasted >8 months beyond the time it was monitored. Acute infection was associated with increased CD4 and CD8 T EM cell frequency ( P = 0.04, P = 0.03, respectively), decreased interferon (IFN)‐γ production from T‐cells (2.8% vs 11.3%; P = 0.006), and decreased CD8 TEMRA frequency (4.56% vs 11.70%; P = 0.006). Conclusions: Early in the pandemic, COVID‐19 disease was mostly mild in pediatric SOT recipients with no rejection, patient death, or graft loss observed.