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Severe Acute Respiratory Syndrome Coronavirus-2 Infection in Children With Liver Transplant and Native Liver Disease:
Mohit Kehar1,2,3, Noelle H Ebel3, Vicky L Ng4
1Queen's University, Kingston.
Insights
Children with native liver disease (LD) faced higher severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) risks than liver transplant (LT) recipients. Nonalcoholic fatty liver disease (NAFLD) patients had increased severe SARS-CoV2 disease odds.
Area of Science:
- Pediatric Hepatology
- Infectious Diseases
- Transplantation Immunology
Background:
- Severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) poses risks to adults with liver disease (LD) and liver transplant (LT) recipients.
- Outcomes in pediatric populations with LD and LT infected with SARS-CoV2 are not well-defined.
Purpose of the Study:
- To report the outcomes of children with native LD and LT who were diagnosed with SARS-CoV2 infection.
- To identify risk factors associated with severe SARS-CoV2 disease in pediatric LD and LT patients.
Main Methods:
- A multicenter observational cohort study was conducted.
- Data were collected from 91 pediatric patients (<21 years) with laboratory-confirmed SARS-CoV2 infection between April and September 2020.
- Patients were categorized into native LD (n=44) and LT (n=47) cohorts.
Main Results:
- Patients with native LD were more likely to require hospital admission (70% vs. 43%) and pediatric intensive care unit (PICU) management (32% vs. 4%) compared to LT recipients.
- Seven LD patients required mechanical ventilation, and two died. No LT recipients died or required mechanical ventilation.
- Nonalcoholic fatty liver disease (NAFLD) and native LD were associated with higher odds of severe SARS-CoV2 disease, including PICU admission, vasopressor support, mechanical ventilation, renal replacement therapy, or death.
Conclusions:
- Pediatric liver transplant recipients experienced less severe SARS-CoV2 infection compared to those with native liver disease, despite immunosuppression.
- Patients with NAFLD demonstrated increased odds of severe SARS-CoV2 disease.
- Further research is necessary to evaluate effective treatments and stratify risk in pediatric LD and LT patients with SARS-CoV2 infection.
Objective:
Increased mortality risk because of severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) infection in adults with native liver disease (LD) and liver transplant (LT) is associated with advanced age and comorbid conditions. We aim to report outcomes for children with LD and LT enrolled in the NASPGHAN/SPLIT SARS-CoV2 registry.
Methods:
In this multicenter observational cohort study, we collected data from 91 patients <21 years (LD 44, LT 47) with laboratory-confirmed SARS-CoV2 infection between April 21 and September 17, 2020.
Results:
Patients with LD were more likely to require admission (70% vs 43% LT, P = 0.007) and pediatric intensive care unit (PICU) management (32% vs 4% LT, P = 0.001). Seven LD patients required mechanical ventilation (MV) and 2 patients died; no patients in the LT cohort died or required MV. Four LD patients presented in pediatric acute liver failure (PALF), 2 with concurrent multisystem inflammatory syndrome in children (MIS-C); all recovered without LT. Two LD patients had MIS-C alone and 1 patient died. Bivariable logistic-regression analysis found that patients with nonalcoholic fatty LD (NAFLD) (odds ratio [OR] 5.6, P = 0.02) and LD (OR 6.1, P = 0.01, vs LT) had higher odds of severe disease (PICU, vasopressor support, MV, renal replacement therapy or death).
Conclusions:
Although not directly comparable, LT recipients had lower odds of severe SARS-CoV2 infection (vs LD), despite immunosuppression burden. NAFLD patients reported to the registry had higher odds of severe SARS-CoV2 disease. Future controlled studies are needed to evaluate effective treatments and further stratify LD and LT patients with SARS-CoV2 infection.
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