#46 A Multicenter Study Exploring the Epidemiology and Outcomes of COVID-19 Among Pediatric Hematopoietic Cell Transplant, Cellular Therapy and Solid Organ Transplant Recipients: Preliminary Results from the Pediatric COVID-19 U.S. Registry.
Authors: Dallas Ronald H 
Published: June 2022

Abstract

Background
While most pediatric patients with COVID-19 experience mild disease, children with a history of hematopoietic cell transplant or cellular therapy (HCT/CT) or solid organ transplant (SOT) may be at increased risk for severe disease. Despite this, there is a dearth of data from multicenter studies examining COVID-19 outcomes among pediatric HCT/CT and SOT recipients. We present descriptive results from the Pediatric COVID-19 U.S. registry to characterize COVID-19 illness among pediatric HCT/CT and SOT recipients across the United States.

Method
Demographic, medical history, and COVID-19 related data were extracted from HCT/CT and SOT recipient medical records and submitted to the Pediatric COVID-19 U.S. Registry, a passive surveillance registry of pediatric patients less than 21 years old diagnosed with COVID-19 between March 2020 and April 2021. Participating US centers (n=170) submitted de-identified information for inpatients and outpatients at 7- and 28-days post COVID-19 diagnosis via a publicly available REDCap electronic survey. Data were summarized descriptively to characterize COVID-19 hospitalizations among HCT/CT and SOT recipients.

Results
Of the 13,140 registry COVID-19 cases, a total of 202 (1.5%) were patients with history of HCT/CT (n=58) or SOT (n=144). Median age at COVID-19 diagnosis among HCT/CT was 9.5 years (range 0.66 to 18) and SOT was 13.5 years (range 1 to 20). Over half of HCT (64%) and SOT (53.8%) patients were White/Caucasian and 26% of HCT and 39% of SOT here Hispanic/Latino. Hospitalizations among HCT/CT and SOT accounted for approximately 12% of all hospitalizations reported to the registry (n = 1683). Almost half of the reported HCT/CT (48%) and SOT (44%) cases were hospitalized. In those hospitalized, 11 (19%) HCT and 18 (12.5%) SOT cases required ICU admission. Half (50%) of HCT hospitalized cases received oxygen support and 3 (11%) required mechanical ventilation while only 2 (0.6%) SOT cases received oxygen support, and none required mechanical ventilation. The majority of HCT/CT cases (64%) were hospitalized between Days 100 and 365 post-transplant. Approximately half (48%) of the HCT cases had received an allogenic HCT. Myeloablative conditioning was the most common regimen reported (48%) among hospitalized HCT cases. Approximately half of SOT hospitalized cases had received a kidney transplant (48%) followed by liver (30%) and heart (19%). Of the 63 hospitalized SOT cases, the majority (87%) were receiving tacrolimus at COVID-19 diagnosis. One SOT death related to COVID-19 was reported, while no related deaths were reported in the HCT/CT group.

Conclusion
Although HCT/CT and SOT cases were low in comparison to all cases submitted to the registry, almost half of these cases required hospitalization. Only one COVID-19 related death was reported (SOT group); however, up to 20% of cases received ICU care. This data may aid clinicians developing future prospective studies examining COVID-19 risk mitigation and effective treatment strategies among this increased-risk population.