Immunosuppression Management, Outcomes And Challenges In Children With Liver And Kidney Transplant Recipients In The Covid-19 Pandemic Single Center Experience

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Purpose: The COVID-19 pandemic has had a significant impact on solid organ transplantation (SOT), creating challenges in clinical management and contributing to substantial morbidity and mortality. By presenting our experience with immunosuppressive therapy management during COVID-19 infection in liver and kidney transplant recipients followed at our center, we want to raise awareness among transplant physicians about the effects of COVID-19 and discuss their management.Methods: The files of patients who were followed up with a diagnosis of COVID-19 at the Istanbul Faculty of Medicine Pediatric Pandemic Service and outpatient clinic between January 2020 and January 2023 were retrospectively evaluated. Demographic characteristics, transplantation characteristics, immunosuppression treatments, COVID-19 severity, and laboratory parameters were evaluated.Results: Thirty children diagnosed with COVID-19, with a history of liver and kidney transplantation, were included in the study. Twenty-one of these patients (n = 21, 70%) were liver transplant recipients and 9 (n = 9, 30%) were kidney transplant recipients. A total of 53.3% of the patients were male (n = 16) and the mean age was 10.1±4,85 years. Mild-to-moderate disease was observed in 93.3% patients. The rate of comorbidities, such as hypertension, obesity, and chronic lung disease, was 16.7%, and the hospitalization rate was significantly higher in these patients (p = 0.014). Of the nine patients whose immunosuppressive treatment was discontinued, three were kidney transplant recipients and six were liver transplant recipients; there was no statistically significant difference between them in terms of treatment discontinuation (p = 1,000). Patients in whom immunosuppressive treatment was discontinued had a significantly higher rate of severe disease (p = 0.049). Myocarditis was detected in one kidney transplant patient. No mortality was observed in any patient. The COVID-19 vaccination rate among patients was 13% (n = 4/30).Conclusions: Pediatric liver and kidney transplant recipients generally experienced mild COVID-19 courses without mortality. Comorbidities were associated with hospitalization. Severe disease was linked to immunosuppressive discontinuation, particularly mycophenolate mofetil. Our findings highlight the importance of individualized immunosuppression management during COVID-19 in pediatric transplant recipients.

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