COVID-19 presentation in pediatric patients with visceral transplantation

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) pandemic has become one of the most challenging episodes in the history of modern public health, with particular emphasis in high risk population. However, the evidence regarding their response to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov-2), the agent responsible for COVID-19 is scant. Herein we present the clinical course of the SARSCoV- 2 infection in four pediatric patients that had underwent visceral transplantation. Methods: pediatric patients (3 with mulvisceral transplant and 1 hepatointestinal transplant;median age 13,75 years, range 12-17 years) were diagnosed with SARS-CoV-2 infection by nucleic acid amplification test, antigen test or serologic anti-SARS-CoV-2 IgM detection. Lymphocytes count, clinical signs and seroconversion were assessed. Results:3/4 consulted for symptoms compatible with COVID-19 and had a mild clinical presentation. Patient I headache and muscle pain, Patient II Anosmia and agusia, cough and rhinorrhea, Patient III sore throat, cough and rhinorrhea. Patient IV was asymptomatic and consult for epidemiological environment. Lymphocytes count at the time of diagnosis was between normal range (media 3600 cells/ul of blood, range 2600-4600 cells/ul of blood) and, interestingly, no gastrointestinal symptoms were reported. Of note, immunosuppression was not suspended nor diminished during the episode. 4/4 were receiving Tacrolimus (blood levels median 7.7ng/ ml, range 6.7-8.4 ng/ml) and 3/4 also corticoids (median 5 mg/day, range 2-10 mg/day). Finally, until today we could detect specific IgG antibodies against SARS-CoV-2 in serum after recovery in 3 of the patients (one is still pending). Conclusion: The results presented here suggest that SARS-CoV-2 infection in pediatric patients with visceral transplantation is asymptomatic/mild. Interestingly, despite their graft altered immune status, no gastrointestinal symptoms were observed. Additionally, despite the high immunosuppression levels used, seroconversion was achieved in all patients so far. All together, these results suggest that collaboration between B and T cells was not affected by the pharmacological treatment and that pediatric patients would not constitute a risk group.