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1.
Pediatrics ; : e2022059237, 2023.
Article in English | EuropePMC | ID: covidwho-2214881

ABSTRACT

As of June 15, 2022, the Centers for Disease Control and Prevention has reported 296 pediatric patients under investigation for hepatitis of unknown etiology in the United States;the World Health Organization has reported 650 probable cases worldwide. One of the leading hypotheses for this cluster of cases is adenovirus, a virus that commonly causes respiratory or gastrointestinal symptoms in healthy children but rarely causes severe hepatitis or acute liver failure in immunocompetent children. The other leading hypothesis is that prior infection with SARS-CoV-2 may predispose children to developing liver injury from a normally innocuous agent. We describe a case of a previously healthy child presenting with acute liver failure who had detectable adenovirus DNA in his stool, whole blood, and in liver explant tissue, suggesting adenovirus as the likely etiology for the liver failure. He had no evidence of prior or current SARS-CoV-2 infection, nor had he received COVID vaccination, suggesting that SARS-CoV-2 did not play a role. Additionally, we report on the ability to provide rapid evaluation of a living donor within 72 hours and successfully perform a lifesaving, left-lobe, living donor liver transplant.

2.
Semin Pediatr Surg ; 31(3): 151178, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1852061

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has significantly impacted all aspects of healthcare including solid organ transplantation. In this review, we discuss the specific impact of COVID-19 on the pediatric solid organ transplant population including access to grafts for pediatric transplant candidates as well as COVID-19 disease manifestations in pediatric transplant recipients. We address the current knowledge of prevention and management of COVID-19 in pediatric transplant recipients and provide additional information regarding social distancing, infection prevention and return to school.


Subject(s)
COVID-19 , Organ Transplantation , Child , Humans , Pandemics/prevention & control , SARS-CoV-2 , Transplant Recipients
4.
Clin Infect Dis ; 73(10): 1920-1923, 2021 11 16.
Article in English | MEDLINE | ID: covidwho-1522136

ABSTRACT

Nationally, immunization delivery has decreased significantly during the coronavirus disease 2019 (COVID-19) pandemic. Internationally, >60 national vaccine programs have been disrupted or suspended. As a result of these immunization declines, the global community is at risk for a resurgence in vaccine-preventable infections including measles, pertussis, and polio-all highly contagious diseases that result in significant morbidity and mortality in children. Measles outbreaks have already occurred in many countries that suspended their vaccination programs. Outbreaks in the United States are likely to occur when social distancing stops and children return to school. Healthcare providers have acted quickly to institute multiple risk mitigation strategies to restore vaccine administration. However, childhood immunization rates remain below pre-COVID-19 levels. Partnerships between healthcare providers, community leaders, and local, state, regional, and national public health departments are needed to reassure families that vaccine delivery during COVID-19 is safe and to identify and catch up those children who are underimmunized.


Subject(s)
COVID-19 , Vaccines , Child , Humans , Immunization , Immunization Programs , SARS-CoV-2 , United States/epidemiology , Vaccination
5.
Pediatr Transplant ; 26(2): e14162, 2022 03.
Article in English | MEDLINE | ID: covidwho-1462869

ABSTRACT

BACKGROUND: The COVID-19 pandemic has affected all aspects of the US healthcare system, including liver transplantation. The objective of this study was to understand national changes to pediatric liver transplantation during COVID-19. METHODS: Using SRTR data, we compared waitlist additions, removals, and liver transplantations for pre-COVID-19 (March-November 2016-2019), early COVID-19 (March-May 2020), and late COVID-19 (June-November 2020). RESULTS: Waitlist additions decreased by 25% during early COVID-19 (41.3/month vs. 55.4/month, p < .001) with black candidates most affected (p = .04). Children spent longer on the waitlist during early COVID-19 compared to pre-COVID-19 (140 vs. 96 days, p < .001). There was a 38% decrease in liver transplantations during early COVID-19 (IRR 0.62, 95% CI 0.49-0.78), recovering to pre-pandemic rates during late COVID-19 (IRR 1.03, NS), and no change in percentage of living and deceased donors. White children had a 30% decrease in overall liver transplantation but no change in living donor liver transplantation (IRR 0.7, 95% CI 0.50-0.95; IRR 0.96, NS), while non-white children had a 44% decrease in overall liver transplantation (IRR 0.56, 95% CI 0.40-0.77) and 81% decrease in living donor liver transplantation (IRR 0.19, 95% CI 0.02-0.76). CONCLUSIONS: The COVID-19 pandemic decreased access to pediatric liver transplantation, particularly in its early stage. There were no regional differences in liver transplantation during COVID-19 despite the increased national sharing of organs. While pediatric liver transplantation has resumed pre-pandemic levels, ongoing racial disparities must be addressed.


Subject(s)
COVID-19 , Health Services Accessibility/trends , Healthcare Disparities/trends , Liver Transplantation/trends , Waiting Lists/mortality , Adolescent , Child , Child, Preschool , Female , Healthcare Disparities/ethnology , Humans , Infant , Infant, Newborn , Living Donors/statistics & numerical data , Male , Registries , Retrospective Studies , United States
6.
American Journal of Transplantation ; n/a(n/a), 2021.
Article in English | Wiley | ID: covidwho-1408329

ABSTRACT

Abstract While many adult solid organ transplant recipients (SOTRs) have impaired antibody response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, pediatric SOTRs? response has not been assessed.1-2 We report the immunogenicity and safety of BNT162b2 mRNA vaccination in pediatric SOTRs.

7.
Pediatr Transplant ; 24(8): e13816, 2020 12.
Article in English | MEDLINE | ID: covidwho-670328

ABSTRACT

Amidst the coronavirus (COVID-19) pandemic, the American Society for Transplant Surgeons has recommended that only urgent liver transplant with deceased donors should occur. However, young pediatric candidates rely on living donors for lifesaving transplant. We present a case of non-directed left lateral lobe living liver donor transplant for a 7-month-old child with biliary atresia experiencing repeated life-threatening episodes of sepsis and cholangitis from infected bile lakes. Using careful preoperative planning among the entire multidisciplinary team, paying meticulous attention to infection control pre- and post-operatively, and taking advantage of robust telehealth technology both in and out of the hospital, a successful transplant was achieved. Amidst the COVID pandemic, non-directed liver transplantation can be safely achieved for pediatric recipients.


Subject(s)
Biliary Atresia/surgery , COVID-19 , Liver Transplantation , Female , Humans , Infant , Living Donors , Remission Induction , Tissue and Organ Procurement , Treatment Outcome
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