Experience in a COVID19 nephrology center and pediatric kidney transplant
Gabriela Gutiérrez 1, Angeles Peiró1, Julian Vega1, Miguel Franco1, Jose Fretes1, Sylvia Gotz1, Jazmin Alvarez1, Marianela Fernandez1, Paola Avalos1, Carolina Avalos1, Leticia Florentín de Merech1.
1Departamento de Nefrología Pediátrica, Facultad de Ciencias Médicas de la Universidad Nacional de Asunción, San Lorenzo, Paraguay
Introduction: Pediatric patients with solid organ transplant are considered a population at risk for the development of infections and their complications. The literature suggests that, despite the increased risk of infections, children on immunosuppressive therapy for organ transplant presents a relatively low risk of adverse evolution due to COVID-19.
Objectives: Describe clinical characteristics, management and evolution of patients with kidney transplant and COVID-19.
Method and Material: Observational study, descriptive, retrospective, cross-sectional, review of medical records. Population constituted by pediatric patients with kidney transplant, diagnosed with COVID-19, from March 2020 to June 2021. Diagnosis confirmed by SARS‐CoV‐2 detection by PCR - nasal swab.
Results: Of 13 kidney transplant patients, 3/13 (23%) had a diagnosis of COVID-19, PCR swab taken in the first 72 hours of onset of symptoms. Male 2/3. Average age 15.6 years (range 11-17). living donor related 2/3, cadaveric 1/3. They had symptoms consistent with COVID-19: cough and nasal congestion 3/3, fever 1/3, abdominal pain 1/3. Had contact with a confirmed case of COVID-19: 2/3. everyone received immunosuppression with Tacrolimus + Mycophenolate Mofetil + Prednisone. Only 1 required a dose reduction of Mycophenolate, due to leukopenia that was normalized after 10 days of evolution. 2/3 were hospitalized due to elevation of inflammatory markers (Ferritin and Dimer-D) and underlying pathology not by severity criteria. Average length of stay 21 days (range 18-24). The 2 internees received corticotherapy (dexamethasone) and antibiotic (azithromycin) by Institutional protocol. Serology was performed at 15 days and all presented IgM+, any patient had received the vaccine. None of the patients had renal graft failure, and did not develop respiratory insufficiency. No deaths were recorded.
Conclusion: The Symptoms and mild signs coincide with what has been reported in the general population. On our patients, COVID‐19 was not associated with dysfunction or loss of graft, respiratory failure, or deaths. Only one patient required reduction of immunosuppression during hospitalization. There are few studies on this population with this specific virus, so the experience of each center in the handling and follow-up when being shared favors the generation of protocols adapted to the underlying pathology. It is difficult to decide the management immunosuppressant in critically ill patients, due to the high risk of rejection. It is necessary to carry out multicenter studies for the best therapy and long-term follow-up.
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