COVID-19 in pediatric kidney transplantation: a follow-up report of the Improving Renal Outcomes Collaborative

Abstract

Background We report follow-up data from an ongoing prospective cohort study of COVID-19 in pediatric kidney transplantation through the Improving Renal Outcomes Collaborative (IROC). Methods Patient-level data from the IROC registry were combined with testing, indication, and outcomes data collected to describe the epidemiology of COVID testing, treatment, and clinical outcomes; determine the incidence of a positive COVID-19 test; describe rates of COVID-19 testing; and assess for clinical predictors of a positive COVID-19 test. Results From September 2020 to February 2021, 21 centers that care for 2690 patients submitted data from 648 COVID-19 tests on 465 patients. Most patients required supportive care only and were treated as outpatients, 16% experienced inpatient care, and 5% experienced intensive care. Allograft complications were rare, with acute kidney injury most common (7%). There was 1 case of respiratory failure and 1 death attributed to COVID-19. Twelve centers that care for 1730 patients submitted complete testing data on 351 patients. The incidence of COVID-19 among patients at these centers was 4%, whereas the incidence among tested patients was 19%. Risk factors to predict a positive COVID-19 test included age > 12 years, symptoms consistent with COVID-19, and close contact with a confirmed case of COVID-19. Conclusions Despite the increase in testing and positive tests over this study period, the incidence of allograft loss or death related to COVID-19 remained extremely low, with allograft loss or death each occurring in < 1% of COVID-19-positive patients and in less than < 0.1% of all transplant patients within the IROC cohort. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information Supplementary Information The online version contains a graphical abstract available at 10.1007/s00467-022-05570-w.

COVID-19 in Children with Chronic Kidney Disease; Does it Differ Much?

“…Similarly, Weinbrand-Goichberg et al reviewed the data of 71 children and young adults with kidney disease and COVID-19, and demonstrated that only one patient had moderate infection, the rest were asymptomatic or had mild disease, and there was no patient with severe disease [19]. In accordance, a recently published study from the USA reviewed 109 pediatric kidney transplant patients with COVID-19 and reported that only one patient developed respiratory failure and one death was observed [21]. However, these stud- ies reported mainly from the more developed parts of the world like Europe, the United Kingdom, Israel, and the USA.…”

“…The underlying mechanism of the AKI is mostly associated with tubular injury, infrequently microangiopathic injury or collapsing glomerulopathy could be observed. Patients with comorbidities like CKD were more likely to develop AKI [26] and AKI incidence varies between 7-36 % in children with chronic kidney disease [7,8,21,24]. Patients with kidney transplantation or flares of nephrotic syndrome seemed more likely to develop AKI.…”

“…In contrast to adults, data on COVID-19 in pediatric patients with kidney disease is scarce. The clinical course in children with CKD has been shown to be mild in the available limited number of studies 15 16 17 18 19 20 . Melgosa et al reported 16 children with chronic renal pathologies and with SARS-CoV-2 infection from Spain, there was no patient with severe COVID-19 and no patient died 20 .…”

Increasing SARS-CoV-2 seroprevalence among UK pediatric patients on dialysis and kidney transplantation between January 2020 and August 2021

“…From January 2021, more patients tested positive for anti-SARS-CoV-2 antibodies; 41% of seropositive patients had no known prior exposure. There is now good evidence that children have a low risk of developing severe COVID-19 [ 32 – 34 ]. Our seroprevalence data from asymptomatic or subclinical patients adds to this evidence.…”

The humoral immune response to the BNT 162B2 vaccine in pediatrics on renal replacement therapy

“…[1][2][3] In contrast, there is accumulating evidence that PKTRs and HR are not at increased risk of severe COVID-19. [4][5][6][7][8][9] As with all healthy children, fever and upper respiratory tract symptoms were the most common presentations. 10 Currently, PKTRs and HR are prioritized for the COVID-19 vaccine, although they were excluded from SARS-CoV-2 mRNA vaccine efficacy and safety trials in children.…”