Severe Acute Respiratory Syndrome Coronavirus-2 Infection in Children With Liver Transplant and Native Liver Disease: An International Observational Registry Study

• Type of Material: Article
• Authors: Mohit Kehar, Queen's University, Kingston; Noelle H Ebel, Stanford University; Vicky L Ng, Hospital for Sick Children, Toronto; Jairo Eduardo Rivera Baquero, Fundacion Cardiofantil; Daniel H Leung, Texas Children's Hospital; Voytek Slowik, Children's Mercy – Kansas City; Nadia Ovchinsky, Children's Hospital at Montefiore; Amit A Shah, Childrens Hospital of Philadelphia; Ronen Arnon, Mount Sinai Hospital; Tamir Miloh, University of Miami; Nitika Gupta, Emory University; Saeed Mohammad, Ann & Robert H. Lurie Children's Hospital; Debora Kogan-Liberman, Children's Hospital at Montefiore; James E Squires, UPMC Children's Hospital of Pittsburgh, Pittsburgh; Maria Camila Sanchez, Hospital Italiano de Buenos Aires; Amber Hildreth, Rocky Mountain Hospital for Children; Linda Book, Primary Children's Hospital; Christopher Chu, Children's Hospital Los Angeles; Leina Alrabadi, Hospital for Sick Children, Toronto; Ruba Azzam, University of Chicago; Bhavika Chepuri, Hospital for Sick Children, Toronto; Scott Elisofon, Boston Children's Hospital; Rachel Falik, UPMC Children's Hospital of Pittsburgh; Lisa Gallagher, University of California San Francisco; Howard Kader, University of Maryland School of Medicine; Douglas Mogul, Johns Hopkins Hospital; Quais Mujawar, University of Manitoba; Shweta S Namjoshi, Hospital for Sick Children, Toronto; Pamela L Valentino, Yale University; Bernadette Vitola, Medical College of Wisconsin; Nadia Waheed, Children's Hospital and the Institute of Child Health; Ming-Hua Zheng, Wenzhou Medical University; Steven Lobritto, Columbia University; Mercedes Martinez, Columbia University
• Language: English
• Date: 2021-06-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Final Published Version
• Copyright Statement: © 2021 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition
• Final Published Version (URL): http://dx.doi.org/10.1097/MPG.0000000000003077
• Title of Journal or Parent Work: JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION
• Volume: 72
• Issue: 6
• Start Page: 807
• End Page: 814
• Keywords: Pediatrics; pediatric liver transplant; COVID-19; Life Sciences & Biomedicine; viral hepatitis; RECIPIENTS; chronic liver disease; acute liver failure; Science & Technology; multisystem inflammatory syndrome in children; Gastroenterology & Hepatology; severe acute respiratory syndrome coronavirus-2 infection; INJURY; Nutrition & Dietetics

Abstract

OBJECTIVE: Increased mortality risk because of severe acute respiratory syndrome coronavirus-2 (SARS-CoV2) infection in adults with native liver disease (LD) and liver transplant (LT) is associated with advanced age and comorbid conditions. We aim to report outcomes for children with LD and LT enrolled in the NASPGHAN/SPLIT SARS-CoV2 registry. METHODS: In this multicenter observational cohort study, we collected data from 91 patients <21 years (LD 44, LT 47) with laboratory-confirmed SARS-CoV2 infection between April 21 and September 17, 2020. RESULTS: Patients with LD were more likely to require admission (70% vs 43% LT, P = 0.007) and pediatric intensive care unit (PICU) management (32% vs 4% LT, P = 0.001). Seven LD patients required mechanical ventilation (MV) and 2 patients died; no patients in the LT cohort died or required MV. Four LD patients presented in pediatric acute liver failure (PALF), 2 with concurrent multisystem inflammatory syndrome in children (MIS-C); all recovered without LT. Two LD patients had MIS-C alone and 1 patient died. Bivariable logistic-regression analysis found that patients with nonalcoholic fatty LD (NAFLD) (odds ratio [OR] 5.6, P = 0.02) and LD (OR 6.1, P = 0.01, vs LT) had higher odds of severe disease (PICU, vasopressor support, MV, renal replacement therapy or death). CONCLUSIONS: Although not directly comparable, LT recipients had lower odds of severe SARS-CoV2 infection (vs LD), despite immunosuppression burden. NAFLD patients reported to the registry had higher odds of severe SARS-CoV2 disease. Future controlled studies are needed to evaluate effective treatments and further stratify LD and LT patients with SARS-CoV2 infection.