Korean J Transplant.  2022 Nov;36(Supple 1):S253. 10.4285/ATW2022.F-3923.

COVID-19 in pediatric liver transplant recipients from a single center in Thailand

• Polsawat W
• Tubjaroen C
• Prachuapthunyachart S
• Eiamkulbutr S
• Chaijitraruch N
• Chongsrisawat V

• KMID: 2535470
• DOI: http://doi.org/10.4285/ATW2022.F-3923

Abstract

Background
Children with immunosuppression may be at risk of severe coronavirus disease 2019 (COVID-19). The outcomes of COVID-19 on pediatric liver transplant recipients (PLTR) are variable and there are limited data available in Thailand. This study aims to report the impact of COVID-19 on pLTR at the current transplant center.
Methods
PLTR under 18 years old, who had COVID-19 infection from April 2020 to July 2022, were included. Data were retro-spectively reviewed, including demographics, clinical presentation, laboratory, and treatment outcomes.
Results
A total of 38 PLTR (50% male) with COVID-19 infection were identified. Ten (28%) received two doses of BNT162b2 and 14 (38%) did not vaccination. The median age was 7.1 (range, 4.2–10.1) years. The median time from transplantation to infection was 55.5 (range, 28.5–86) months. Twenty-nine patients (76.3%) were symptomatic. The most common symptoms were fever (65%), followed by sore throat (26%) and rhinorrhea (21%), respectively. There were neither gastrointestinal nor lower respiratory symptoms. The median AST and ALT were not different between pre- and post-infection. PLTR who received mycophenolate mofetil (MMF) developed lower total white blood cell count, compared with other regimens (2,320 [1780–3112] vs. 4,450 [3750– 5316]/cu mm., P<0.001). Prednisolone, MMF and tacrolimus were used in 10%, 23%, and 80%, respectively. Immunosuppression was modified in 5.2% of patients after infection, all of which was MMF dose reduction. Three (7.8%) patients were hospitalized, two of whom were treated with favipiravir. The rest (35 patients, 82.8%) were treated with favipiravir outpatient. The median du-ration of symptoms was 2.3 (range, 0.7–3) days. All patients recovered without disease progression or liver graft dysfunction. No mortality was observed.
Conclusions
PLTR receiving immunosuppression might not be at risk of severe COVID-19. COVID-19 in PLTR poses no signifi-cant impact on liver graft survival and morbidity. Immunosuppression dose adjustment may not be necessary.