COVID-19 in a pediatric heart transplant recipient: Emergence of donor-specific antibodies

Abstract

turbo-field-echo sequence-4 chamber view). No focal fibrosis was detected in late gadolinium enhancement sequences (Figure 1c, single-shot inversion recovery sequence-4 chamber view). Global edema in T2 weighted images was visible (Figure 1d, T2 [short tau inversion recovery] sequence-3 chamber view) as well as globally elevated T2 (56 ms, referent 48 § 3 ms) (Figure 1e, T2 mapping-short-axis view) and T1 (1,090 ms, referent 989 § 28 ms) (Figure 1f, T1 mapping -short-axis view) mapping times, suggesting acute myocardial injury. On March 26, 2020, hypoxic respiratory failure (saturation of 80%) required mechanical ventilation. The patient improved and was extubated, and the level of cardiac biomarkers declined (N-terminal proBtype natriuretic peptide 631 ng/liter, troponin 61 ng/liter) in due course.Cardiac MRI with its unique accuracy in defining cardiac morphology and function and its ability to provide tissue characterization makes it well suited to study cardiac involvement in COVID-19. Recently, Inciardi et al 3 proved severe biventricular myocardial injury with edema and late gadolinium enhancement. In the absence of epicardial coronary artery stenosis, sub-clinical myocardial dysfunction in COVID-19 may be a consequence of an impairment of microcirculatory endothelial function observed during the early stages of the systemic inflammatory response to the infection, which portends a poor prognosis in patients with established cardiovascular disease and impaired microcirculatory endothelial function. 4 In addition, direct COVID-19-mediated infection of endothelial cells might contribute to cardiac injury. 5 In summary, we show that elevated biomarkers of cardiac injury were associated with generalized myocardial edema without late gadolinium enhancement in cardiac MRI despite a normal echocardiogram during COVID-19.

Multicenter Clinicopathologic Correlation of Kidney Biopsies Performed in COVID-19 Patients Presenting With Acute Kidney Injury or Proteinuria

“…Emergence of de novo donor specific antibodies has also been recently been reported in a pediatric heart transplant recipient who was infected with SARS-CoV-2. 44 Kidney allograft recipients may therefore be at increased risk for developing de novo DSAs and active antibody-mediated rejection after SARS-CoV-2 infection.…”

Gastrointestinal presentation of COVID-19 in a pediatric heart transplant recipient

“…In the case report by Russell MR et al [ 10 ], the patient was admitted to receive intravenous immunoglobulin 1 week after surveillance laboratory studies showed anti-human leukocyte antigen antibody. Because of the history of cough, SARS-CoV-2 reverse transcriptase polymerase chain reaction test was performed and returned positive.…”

“…Because of the history of cough, SARS-CoV-2 reverse transcriptase polymerase chain reaction test was performed and returned positive. They suggested that careful measurement of donor-specific antibodies be undertaken in heart transplant survivors of COVID-19 [ 10 ].…”

Impact of COVID-19 Pandemic on Pediatrics and Pediatric Transplantation Programs

“…Best practice development has focused on the epidemiology and impact of SARS-CoV-2 in SOT patients, community penetrance of COVID-19 disease and school-specific infection prevention intervention implementation in a consensus document recently published (54). Although pediatric SOT recipients are at increased risk for severe manifestations of common infections (55), case reports and case series of SARS-CoV-2 infection in pediatric SOT emerging thus far suggest pediatric SOT recipients are at similar risk and present with a similar spectrum of infection as other children (19,(56)(57)(58)(59); however data are significantly limited and caution is still recommended. For example, an evaluation of the UK Transplant Registry linked with the National Health Service Digital Tracing Services identified only three cases of SARS-CoV-2 among 1,703 pediatric SOT recipients (0.5%) and no deaths occurred during a 4-month period during the height of the first wave of the pandemic in the UK (60).…”