Clinical outcome and antibody response in COVID-19-positive pediatric kidney and liver transplant recipients

Background: The COVID-19 pandemic has profoundly impacted transplantation activity worldwide. Nevertheless, data on the clinical and laboratory features of SARSCoV-2 infection in pediatric recipients of solid organ transplant (SOT) recipients are scarce. Methods: We describe clinical and laboratory manifestations, including serologic response, and short-term outcomes of 25 pediatric recipients of SOT who tested positive for SARS-CoV-2 during the first nine months of the epidemic in Israel. Results: The mean age was 15.2±4 years;14 (56%) were kidney and 11 (44%) liver transplant recipients. Twenty-three (92%) of the patients were symptomatic. The most common symptoms were fever (44%), headache (44%), cough (40%), and fatigue (36%). Most (84%) had a mild disease. Two patients (8%), both kidney transplant recipients with additional comorbidities, had severe respiratory disease and required adjustments in their immunosuppression therapy. None were admitted to the pediatric intensive care unit or died, and all the patients fully recovered after a median of 27 [interquartile range 21-41] days. Significantly longer virus shedding time was found among kidney and pancreas transplanted recipients than among liver transplant recipients (35.1±9.8 vs.19.6±4.7 days, p=0.0005). Following a median of 7 (5-10.5) weeks after COVID-19 diagnosis, 3 (22%) reported residual symptoms, mainly fatigue;22/23 (96%) had positive antibody responses. Conclusions: Our study demonstrated that while the majority of pediatric recipients of SOT developed a mild disease with a positive serologic response, a relatively high percentage (8%) developed a severe disease. This emphasizes the need for close monitoring of this particular population, especially those with comorbidities.