Covid-19 and pediatric kidney transplantation: iberoamerican multicentric study
Sebastián Tobia1,8, Catalina Tessi2, Tatiana Szklars2, Juan P. Corbetta2, Rosa M. Romero Ruiz3, Sebastian Roldan Pérez3, Ramiro Perea4, Anabella Maiolo1, Jimena Krikorian1, German Falke5, Andrea Exeni5, Juan Moldes6, Roberto Vagni6, María C. De Lorenzi6, Luis Garcia Aparicio7, Sonia Perez Bertoles7, Ignacio P. Tobia González8.
1Servicio de Urología, Htal de Niños Sor Maria Ludovica, La Plata, Argentina; 2Servicio de Urologia, Hospital Garrahan., Ciudad Autonoma de Buenos Aires, Argentina; 3Servicio de Urología, Hospital Universitario Virgen del Rocío, Sevilla, Spain; 4Servicio de Trasplante Renal, Hospital El Cruce, Florencio Varela, Argentina; 5Servicio de Urología, Hospital Universitario Austral, Pilar, Argentina; 6Servicio de Cirugía Infantil, Hospital Italiano, Ciudad Autónoma de Buenos Aires, Argentina; 7Servicio de Urología, Hospital Sant Joan de Déu, Barcelona, Spain; 8Cátedra de Urología, Facultad de Ciencias Médicas - UNLP, La Plata, Argentina
Introduction: Concern on the effect of COVID-19 in children recipients of kidney transplant (KT) lead to an initial decline in the transplantation activity. Our aim is to present graft and clinical outcomes of a multicenter cohort of pediatric KT performed during COVID-19 pandemic and compare it with an historic control group. Our secondary goal is to report the clinical evolution of children who suffered COVID-19 after transplantation.
Methods: A retrospective analysis in seven pediatric KT centers of Iberoamerica, from January 2019 to December 2020 was done. In the included institutions, 168 pediatric KT were performed: 97 patients were control group (year 2019) and 71 the study group (year 2020). Baseline demographics and comorbidities were comparable. Graft outcome showed no significant differences in terms of the need of post transplant renal replacement therapy and glomerular filtration rate in the last visit. Graft hydronephrosis, urinary tract infection, and other complications were similar (Table 1).
Results: Six (8,4%) out of 71 patients transplanted in 2020 developed COVID 19 after the transplant. The infection occurred at a mean 71,8 days after the transplant (range: 5-214 days). Three patients were asymptomatic, two presented with fever and one with cough. Three patients were managed on an outpatient basis, two were admitted but remain in a common room, whereas one child required hospitalization in intensive care unit but, without the need of mechanical ventilatory assistance. In 3 patients mycophenolate was suspended, and in the other 3 there were no changes in the immunosuppressive scheme. There were no mayor respiratory complications such as COVID-19 pneumonia or acute respiratory distress syndrome. Hospital stay was a mean of 13 days (range: 0-39). All six patients had good graft outcome, with no need renal replacement therapy, with a mean glomerular filtration rate of 86,36 mL/min/1.73 m² (range:58 -126). One patient had recurrence of original renal disease.
Conclusion: Despite initial concerns about the increased risk of severe complications of COVID-19 and the graft survival in children with KT, our multicentric series showed similar initial graft outcome and no mayor respiratory complications. Longer follow up is needed to assess the long-term evolution of these grafts and patients.
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