National Study on the Risks of Covid-19 for Paediatric Renal Transplant Recipients

ABSTRACT

From the start of the COVID-19 pandemic evidence emerged that children were less affected by SARS-CoV- 2 PCR DNA COVID-19 positive infections with increasing evidence showing immunosuppressed children were less at risk compared to immunosuppressed adults. The aim of our study was to investigate how COVID-19 infections affected paediatric renal transplant recipients in the UK. Methods Questionnaires regarding patient demographics renal transplant information COVID-19 infection data and care of patients during the COVID-19 pandemic were sent out to all 13 UK paediatric nephrology centres. Results 54 patients (69% male;50% Black Asian and minority ethnic [BAME];57% living donors) aged 4-19 (median 11) years and between 2 months - 15 years (median 3 years 1 month) post-transplantation from nine centres tested positive for SARS-CoV-2 PCR DNA. Four centres had no positive patients. 48% presented with the classical COVID-19 symptoms (37% fever 11% continuous cough and 4% loss of sense of taste or smell);atypical presentations included diarrhoea (13%) and headache (8%). 37% of patients were asymptomatic. 28% were hospitalised (median stay 2 days) which included asymptomatic patients admitted for other reasons. Of those admitted one patient required oxygen;however, no patients required ventilation or intensive care admission. One child had a rejection episode as a complication of the infection and one adolescent had ongoing cardiorespiratory symptoms for six months. There was evidence of AKI with renal transplant dysfunction in 31% of patients, with increase in mean baseline plasma creatinine from 80.6mmol/l to 171.7mmol/l but no patients required CVVH or dialysis. Conclusion 9% of the UK paediatric renal transplantation population have had documented SARS-CoV-2 PCR DNA infections with 28% required hospitalisation. There was increased prevalence of AKI particularly after the first wave of the COVID-19 pandemic possibly due to different variants, although there is no specific virological data to support this.