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

Background: Children with immunosuppression may be at risk of severe coronavirus disease 2019 .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 retrospectively 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 duration 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 significant impact on liver graft survival and morbidity.Immunosuppression dose adjustment may not be necessary.