key: cord-0699222-trhnv850
authors: Dias Curado, Ana; Zagalo, Ana; Durão, Filipa; Costa‐Reis, Patrícia; Sandes, Ana Rita; Esteves da Silva, José Eduardo; Stone, Rosário
title: SARS‐CoV‐2 infection in pediatric kidney transplant recipients
date: 2022-02-28
journal: Clin Transplant
DOI: 10.1111/ctr.14623
sha: d491c90c81dfb46bb7d29a4f49c451536624a57e
doc_id: 699222
cord_uid: trhnv850

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Emerging evidence from adult patients suggests that transplant recipients, who are immunosuppressed, may be at increased risk of a more severe outcome related to Coronavirus disease of 2019 (COVID-19).

Some reports, however, suggest that children have a relatively mild course of disease and have better outcomes when compared with adults. 1, 2 Furthermore, some studies found that pediatric immunosuppressed patients with SARS-CoV-2 infection had a similar prognosis to immunocompetent children. 3, 4 Nevertheless, the outcomes of COVID-19 in pediatric kidney transplant (KT) recipients remain largely unclear.

In our centre, between March 2020 and March 2021, five cases (9%) of COVID-19 infection were identified in a cohort of 55 paediatric KT recipients. In Portugal, the main variants during this period were 20A, 20B, 20E (EU1) and 20I (Alpha, V1), according to local data.

The main results are listed in Table 1 There are currently no evidence-based reports to support specific adjustments to immunosuppressive medications in relation to COVID-19. It must be emphasized that the decision to continue or discontinue any immunosuppression lies with the clinician, guided by local guidelines, with consideration of their potential benefit versus their ongoing immunosuppressive effect. Although reduction of immunosuppression at the time of active infection is reasonable, it may not be necessary as the pulmonary injury is thought to be due to the "cytokine storm" leading to excessive activation of the host innate immune inflammatory response. Hence, being immunosuppressed may actually be of advantage as this may cause minimal to no lung and extra pulmonary tissue damage. 5 In our series, the presentation of COVID-19 in KT recipients was no different from the general pediatric population; the treatment during COVID-19 infection was exclusively supportive, with no immunosuppression reduction; and there was an excellent outcome. Despite the small sample size, these results support that symptomatic treatment in pediatric KT recipients with mild or asymptomatic COVID-19 infection might be sufficient. We believe that the risk of allograft loss outweighs the unknown benefits of the reduction of immunosuppression in mild COVID-19 in pediatric KT recipients. 

COVID-19 in pediatric kidney transplantation: the improving renal outcomes collaborative

COVID-19 infection in a pediatric kidney transplant population: a single-center experience

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

COVID-19 in children treated with immunosuppressive medication for kidney diseases

COVID-19 in immunosuppressed children

The authors of this manuscript have no conflicts of interest to disclose as described by Clinical Transplantation. 

The authors confirm that the data supporting the findings of this study are available within the article.