For a study, researchers sought to describe the prevalence of SARS-CoV-2 infection in pediatric solid organ transplant (SOT) patients in the early stages of the epidemic. They predicted that most SARS-CoV-2 infections in pediatric SOT patients might be asymptomatic.
In order to identify patients who were tested for SARS-CoV-2 between March 15, 2020, and June 30, 2021, they searched the Organ Transplant Tracking Record (OTTR) for all pediatric SOT recipients monitored at the facility. They also looked through medical data. Prior to scheduled operations or in response to symptoms, patients had polymerase chain reaction (PCR) testing. Alternatively, patients underwent testing by measuring IgG to spike protein as part of their routine labs q 2-monthly. Acute infection was described as PCR positive. Convalescence was used to describe a positive IgG and a negative PCR. Blood was taken for immunologic tests when the PCR or IgG was positive. Acute infection vs. convalescence, acute infection versus SOT recipients who were not infected (referred to as healthy controls), liver transplant (LT) versus small bowel (SB)/multivisceral transplant (MVT), and positive versus negative test results were all statistically compared.
Ninety-nine LT recipients out of 257 were evaluated; 6 PCR and 13 positive antibody results were found. Out of 150 SB/MVT recipients, 55 underwent testing; 4 returned PCR and 6 positive antibody results. 8 patients underwent simultaneous liver and kidney transplants; 3 underwent testing; 1 returned a positive PCR result. When symptoms did occur, they tended to be moderate. Positive test results were associated with younger patients (6.3 versus 10.0 years; P=0.017). Within 96 hours, they noticed a sharp drop in viral load without a change in immunosuppression. Over 8 months have passed since the antibody was last observed. Increased CD4 and CD8 TEM cell frequencies (P=0.04, P=0.03, respectively) and decreased interferon (IFN)-γ production from T-cells (2.8% vs. 11.3%; P=0.006) and CD8 TEMRA frequency (4.56% vs. 11.70%; P=0.006) were all related to acute infection.
Early in the pandemic, juvenile SOT recipients with COVID-19 illness primarily experienced minor symptoms; there were no reports of graft loss, patient death, or rejection.