Abstract
Background: In 2019, SARS-CoV-2 causing COVID-19 emerged. Severe COVID-19 symptoms may evolve by virtue of hyperactivation of the immune system. Equally, immunocompromised patients may be at increased risk to develop COVID-19. However, treatment guidelines for children following liver transplantation are elusive.
Methods: As a liver transplantation center, we diagnosed and followed up 10 children (male/female: 8/2) with a median age of 8.5 years (IQR: 5.2-11.0), with COVID-19 post-liver transplant between March 2019 and December 2020. COVID-19 diagnosis was based on PCR test and or florid X-ray findings compatible with COVID-19 in the absence of other cause. We retrospectively collected clinical and laboratory data from electronic patient records following written consent from patients/parents.
Results: Nine patients were diagnosed as definitive (PCR positive) with one patient being diagnosed as probable COVID-19. Seven patients recovered without any support whereas three were admitted for non-invasive oxygenation. Lymphopenia and/or high levels of serum IL-6 were detected in four patients. Six patients mounted anti-SARS-CoV-2 antibodies at median 30 days (IQR: 26.5-119.0) following COVID-19 diagnosis. Antibiotic therapy, favipiravir, anakinra, and IVIG were used as treatment in 4,1,1 and 2 patients, respectively. Furthermore, we kept the tacrolimus with or without everolimus but stopped MMF in 2 patients. Importantly, liver allograft function was retained in all patients.
Conclusions: We found that being immunocompromised did not affect disease severity nor survival. Stopping MMF yet continuing with tacrolimus was an apt treatment modality in these patients.
Keywords: IL-6; SARS-CoV-2; antibody; children; immunosuppression; lymphopenia; solid organ; tacrolimus.
【저자키워드】 SARS-CoV-2, antibody, IL-6, children, Immunosuppression, lymphopenia, tacrolimus, solid organ, 【초록키워드】 COVID-19, Treatment, therapy, Anakinra, antibody, IL-6, disease severity, Immunocompromised patients, Immunosuppression, Favipiravir, immune system, treatment guidelines, IVIG, Immunocompromised patient, lymphopenia, X-ray, serum, anti-SARS-CoV-2 antibodies, survival, anti-SARS-CoV-2 antibody, Patient, COVID-19 diagnosis, Liver transplantation, Immunocompromised, PCR test, liver, patients, liver transplant, tacrolimus, Allograft, solid organ, Oxygenation, COVID-19 symptom, Support, Serum IL-6, Antibiotic therapy, Non-invasive, increased risk, PCR positive, median age, laboratory data, one patient, Electronic patient records, written consent, Hyperactivation, Clinical and laboratory data, severe COVID-19 symptoms, virtue, Everolimus, treatment guideline, probable COVID-19, collected, develop, diagnosed, median, were used, absence, not affect, retained, electronic patient record, MMF, mounted, Stopping, with COVID-19, 【제목키워드】 management, liver, Pediatric patient, single-center, COVID-19 disease course,