Korean J Transplant.  2023 Nov;37(Suppl 1):S48. 10.4285/ATW2023.F-6141.

Risk of COVID-19 infection in pediatric solid organ transplant recipients: a single center study in South Korea

• Baek JY
• Ihn K
• Koh H
• Lee KH
• Kim MY
• Kang JM
• Kim MS

• KMID: 2551635
• DOI: http://doi.org/10.4285/ATW2023.F-6141

Abstract

Background
Solid organ transplant (SOT) recipients are at high risk for severe coronavirus disease 2019 (COVID-19) due to im-munosuppressant (IS) use. Compared to adult SOT recipients (SOTRs), studies on risk and vaccination effectiveness in pediat-ric SOTRs are limited. We aim to investigate the epidemiologic characteristics of COVID-19 infection in pediatric SOTRs.
Methods
This study was conducted at Severance Hospital in Korea, between 1999–2022. All SOTRs received SOT at the age ≤18 years were included. SOTRs who had a history of COVID-19 before SOT were excluded. Severe case was defined when there is oxygen demand. Demographic data and information for risk factor exploration were retrospectively collected through chart review.
Results
A total of 117 SOTRs were included. The median age at SOT was 4.8 years (1.0–10.3 years), and the male to female ratio was 1:1.1. About 82% (96/117) had COVID-19 infection and 10% (10/96) of them were hospitalized for COVID-19 management. Four cases were severe cases and there was no death. Multiple immunosuppressants (IS) and steroid uses were significantly associated with the lower incidence of COVID-19 (odd ratio [OR] 0.15, 95% confidence interval [CI] 0.05–0.54, P=0.002; and 95% CI 0.09–0.58, P=0.003; respectively). Multiple IS and steroid uses were correlated with the shorter duration after SOT (R=–0.40 and –0.42), older age (R=0.30 and 0.19), and more vaccine dose (R=0.31 and 0.24). Older age at SOT was associated with the hospitalization of COVID-19 SOTRs by logistic regression (OR, 1.34; 95% CI, 1.1–1.7; P=0.01). Retransplantation (OR, 21.8; 95% CI, 1.3–357.1; P=0.03) and multiple IS use (OR, 7.6; 95% CI, 1.1–54.2; P=0.04) were associated with the COVID-19 frequency. There was no factor affecting the severity of COVID-19.
Conclusions
Pediatric SOTR is susceptible to COVID-19, especially in older children at SOT, and those who are taking multiple IS as well as those who have undergone re-SOT.