POS-738 SARS-CoV-2 INFECTION IN PEDIATRIC KIDNEY TRANSPLANT RECIPIENTS DURING EARLY AND LATE POST-TRANSPLANT PERIOD: A SINGLE-CENTER REPORT OF 2 CASES

KARAVA, V.; Kondou, A.; Dotis, I.; Miserlis, G.; Antoniadis, N.; Printza, N.

Introduction: Adult kidney transplant (KT) recipients with SARS-CoV-2 infection are susceptible to a more serious COVID-19 disease compared to immunocompetent patients, including more severe pneumonia, longer duration of illness and worse patient prognosis. Moreover, a high risk of allograft damage, possibly leading to allograft loss, has been reported. In contrast, data regarding the clinical course of infected pediatric KT recipients are scarce. Herein, we describe the clinical features, management and outcome of 2 deceased-donor KT pediatric recipients with SARS-CoV-2 infection, occurred during early and late post-transplant period. Method(s): The two cases concerned a 13-year-old boy with Senior-Loken syndrome and an 18-year-old girl, with focal segmental glomerulosclerosis, who received KT 3 months and 7 years before SARS-CoV-2 infection respectively. The boy had received induction therapy with basiliximab, followed by triple maintenance therapy, including oral cyclosporine (70 mg twice per day), mycophenolate mofetil (MMF) (500 mg twice per day) and daily methylprednisolone (10 mg), while the girl's current immunosuppressive treatment consisted in tacrolimus (1.5 mg twice per day), MMF (750 mg twice per day) and methylprednisolone (8 mg) every other day. Allograft function was stable in both patients. Result(s): Close contact with confirmed COVID-19 case was reported in both patients. The boy was asymptomatic, while the girl presented sore throat, tiredness and fever with maximum temperature 38.6 C, which lasted for 48 hours. Chest X-ray was normal in both patients. Initial laboratory findings were common in both patients and included mild lymphocytopenia (920/muL and 868/muL respectively), normal C-reactive protein and liver enzyme levels, and stable serum creatinine and urea levels. MMF was discontinued, while steroid dose was increased by twice in both patients. Due to fever, a 3-day course of azithromycin was administered to the female patient. Normalization of total lymphocyte count permitting the progressive re-initialization of MMF and reduction of steroid dose was observed at 14th and 5th day of the disease respectively. Graft function remained stable in both patients. Conclusion(s): The outcome of SARS-CoV-2 infection during both early and late post-transplant period seems favorable in pediatric KT recipients. Immunosuppression interruption may be beneficial for preventing acute disease complications. Optimal treatment strategies need to be established. No conflict of interestCopyright © 2021