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

The clinical course of SARS-CoV-2 in the pediatric kidney transplant population is not well described.

We performed a retrospective cohort study of a pediatric kidney transplant population at a New York transplant center. Baseline characteristics and clinical course of patients with SARS-CoV-2 positivity (Ab or PCR) were described, and comparison between COVID-positive and COVID-negative transplant patients was performed.

Twenty-two patients had COVID-19 IgG testing performed, eight of whom also had PCR testing. 23% of our cohort had evidence of COVID-19 infection. Four patients had positive IgG only, and one patient had a positive PCR. All five patients with a positive COVID test were female. Two patients had COVID-19 symptoms, which were mild. Of the symptomatic patients, one had a positive PCR at time of symptoms, while the other had a negative PCR during symptoms but subsequently had positive IgG. As compared to patients with COVID-19 negative results, those with COVID-19 positivity were significantly more likely to have a known COVID-19 exposure, and were also more likely to be female. There was no significant difference in time from transplant between the groups. Those in the COVID-positive group had higher baseline antimetabolite dose and CNI troughs, although these did not reach statistical significance.

Pediatric kidney transplant recipients are at risk for development of COVID-19 infection. While this population may be more at risk for SARS-CoV-2 infection due to their immunosuppressed status, their clinical course appears mild and similar to a healthy pediatric population.