Impact of COVID-19 Pandemic on Management of Pediatric Kidney Transplant Recipients

Children appear to be less commonly and less severely affected by COVID-19 than adults, accounting for 1% to 5% of all COVID-19 cases. The COVID-19 pande mic has challenged pediatric kidney transplant programs to provide safe and consistent care during this difficult and unprecedented time. So far during this pandemic, best practices being delivered to pediatric kidney transplant patients are based on available information from published literature and expert opinions. The key areas of pediatric kidney transplant care that may be affected by the COVID-19 pandemic include transplant activity, outpatient clinic activity, monitoring, multidisciplinary care, medications (immunosuppression and others), patient/family education/support, school and employment, and care of pediatric kidney transplant patients who are COVID-19 positive. It has been presumed that children with chronic kidney disease and/or those who take immunosuppressants may be at increased risk for complications from COVID-19 infection; however, available evidence has now suggested that immunosuppressed children with kidney transplant are not at increased risk of severe COVID-19 disease. Clinicians should remain aware that transplant recipients may present with atypical symptoms. In addition, because evidence-based reports to support specific adjustments to immunosuppressive medications in relation to COVID-19 are not yet available, decisions on reduction or discontinuation of immunosuppression should be on a case-by-case basis for kidney transplant recipients who are COVID-19 positive. Reports to support evidence-based management of pediatric kidney transplant patients during the COVID-19 pandemic are lacking; therefore, expert opinion and available knowledge and experience remain subject to biases.