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Updated: Nov 21, 2025
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
COVID-19 in pediatric kidney transplantation: The Improving Renal Outcomes Collaborative
Charles Varnell1,2, Lyndsay A Harshman3, Laurie Smith1
1Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Pediatric kidney transplant (KT) patients in the US experienced a low incidence of COVID-19. Importantly, these children demonstrated excellent short-term outcomes, with no deaths or allograft loss related to the virus.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Transplantation Immunology
Background:
- Limited data exist on COVID-19's impact on pediatric kidney transplant (KT) recipients.
- Understanding outcomes in this vulnerable population is crucial for clinical management.
Purpose of the Study:
- To assess the incidence and clinical outcomes of COVID-19 in pediatric KT patients in the United States.
- To evaluate the severity and complications of SARS-CoV-2 infection in this cohort.
Main Methods:
- A prospective cohort study was conducted across 22 Improving Renal Outcomes Collaborative (IROC) centers.
- Data were collected on 281 pediatric KT patients tested for SARS-CoV-2 via PCR, including indications for testing and clinical outcomes.
- A subanalysis estimated incidence using data from 13 centers with complete testing results.
Main Results:
- Overall, 8.5% of tested pediatric KT patients (24/281) tested positive for SARS-CoV-2.
- Of those infected, 63% were symptomatic, with most managed as outpatients.
- No cases of respiratory failure, allograft loss, or death were associated with COVID-19 in this cohort.
Conclusions:
- Pediatric KT patients in the US exhibit a low estimated incidence of COVID-19.
- Short-term outcomes for pediatric KT patients with COVID-19 are generally excellent, with minimal severe complications observed.
Abstract:
There are limited data on the impact of COVID-19 in children with a kidney transplant (KT). We conducted a prospective cohort study through the Improving Renal Outcomes Collaborative (IROC) to collect clinical outcome data about COVID-19 in pediatric KT patients. Twenty-two IROC centers that care for 2732 patients submitted testing and outcomes data for 281 patients tested for SARS-CoV-2 by PCR. Testing indications included symptoms and/or potential exposures to COVID-19 (N = 134, 47.7%) and/or testing per hospital policy (N = 154, 54.8%). Overall, 24 (8.5%) patients tested positive, of which 15 (63%) were symptomatic. Of the COVID-19-positive patients, 16 were managed as outpatients, six received non-ICU inpatient care and two were admitted to the ICU. There were no episodes of respiratory failure, allograft loss, or death associated with COVID-19. To estimate incidence, subanalysis was performed for 13 centers that care for 1686 patients that submitted all negative and positive COVID-19 results. Of the 229 tested patients at these 13 centers, 10 (5 asymptomatic) patients tested positive, yielding an overall incidence of 0.6% and an incidence among tested patients of 4.4%. Pediatric KT patients in the United States had a low estimated incidence of COVID-19 disease and excellent short-term outcomes.
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