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1
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Bozkurt HB, Özdemir Ö. Changes regarding solid organ transplantation during the COVID-19 pandemic. World J Transplant 2025; 15:100591. [DOI: 10.5500/wjt.v15.i3.100591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 01/22/2025] [Accepted: 02/13/2025] [Indexed: 04/18/2025] Open
Abstract
Coronavirus disease 2019 is caused by severe acute respiratory syndrome coronavirus 2 and emerged in Wuhan, China. It affects millions of people all over the world and has caused the deaths of thousands of people. Mortality rates were higher in transplant recipients and patients awaiting transplantation due to social and psychological issues. It also affected candidates who would be transplant providers and caused the transplant chain to be broken worldwide. The coronavirus disease 2019 pandemic has significantly affected solid organ transplantation procedures and led to various changes in protocols and practices to ensure patient safety and increase transplant success. These include challenges in screening protocols, prioritization of cases, telemedicine and virtual consultations, modified surgical procedures, immunosuppression management, updated research and guidelines, post-transplantation process and difficulties to control side effects, difficulties in organ procurement, and patient education/support. It requires a multidisciplinary approach, close collaboration between transplant teams, and adherence to strict infection control measures to ensure the safety of both transplant recipients and healthcare providers. In this article, we compiled the most important points in an overview of this process.
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Affiliation(s)
- Hayrunnisa Bekis Bozkurt
- Department of Pediatrics, Division of Allergy and Immunology, Ümraniye Research and Training Hospital, İstanbul 34400, Türkiye
| | - Öner Özdemir
- Department of Pediatrics, Division of Allergy and Immunology, Sakarya Research and Training Hospital, Sakarya University, Medical Faculty, Adapazarı 54100, Sakarya, Türkiye
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2
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Alhasan KA, Raina R, Boyer O, Koh J, Bonilla-Felix M, Sethi SK, Amer YS, Coccia P, Temsah MH, Exantus J, Khan SA, Zhong X, Koch V, Duzova A, Vasudevan A, McCulloch M, Allen U, Filler G, Montini G. IPNA clinical practice recommendations on care of pediatric patients with pre-existing kidney disease during seasonal outbreak of COVID-19. Pediatr Nephrol 2025; 40:1795-1815. [PMID: 39733391 PMCID: PMC11946955 DOI: 10.1007/s00467-024-06565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 09/13/2024] [Accepted: 09/13/2024] [Indexed: 12/31/2024]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic, instigated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has profoundly impacted healthcare infrastructures around the globe. While children are usually asymptomatic or have mild symptoms, children with pre-existing kidney conditions require specialized attention. This pivotal report, championed by the International Pediatric Nephrology Association (IPNA), delivers precise and actionable recommendations tailored for pediatric patients with kidney ailments in this pandemic landscape. Central to our findings are rigorous infection control protocols. These are particularly stringent in high-risk zones, emphasizing telehealth's indispensable role, the significance of curtailing in-person consultations, and the imperative of following rigorous guidelines in regions with heightened COVID-19 prevalence. Additionally, the report delves into vaccination approaches for children with kidney issues, highlighting that the choice of vaccine is often governed by regional accessibility and policy frameworks, rather than a universal preference. A notable observation is the potential correlation between COVID-19 vaccines and specific kidney disorders. However, establishing a direct causal link remains elusive. In summary, our research accentuates the critical need for specialized pediatric kidney care during global health crises and reaffirms the continuous research imperative, especially regarding vaccination ramifications.
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Affiliation(s)
- Khalid A Alhasan
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
- Organ Transplant Center of Excellence, King Faisal Specialist Hospital & Research Center, Kidney & Pancreas Health Center, Riyadh, Saudi Arabia.
| | - Rupesh Raina
- Department of Nephrology, Cleveland Clinic Akron General and Akron Children Hospital, Akron, OH, USA
| | - Olivia Boyer
- Paris Cité University, Pediatric Nephrology, Reference Center for Idiopathic Nephrotic Syndrome in Children and Adults, Imagine Institute, Necker Children's Hospital, APHP, Paris, France
| | - Jean Koh
- Department of Paediatric Nephrology, Starship Children's Hospital, Auckland, New Zealand
| | - Melvin Bonilla-Felix
- Department of Pediatrics, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico
| | - Sidharth K Sethi
- Pediatric Nephrology, Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, 122001, Haryana, India
| | - Yasser S Amer
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Clinical Practice Guidelines and Quality Research Unit, Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia
- Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Paula Coccia
- Division of Pediatric Nephrology, Department of Pediatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mohamad-Hani Temsah
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Judith Exantus
- Department of Pediatrics, Faculty of Medicine and Pharmacy, State University of Haïti, State University Hospital of Haïti, Port-Au-Prince, Haiti
| | - Samina A Khan
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Malaya, 50603, Kuala Lumpur, Malaysia
| | - Xuhui Zhong
- Department of Pediatric Nephrology, Peking University First Hospital, Beijing, China
| | - Vera Koch
- Children's Institute Hospital das Clinicas Univ Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ali Duzova
- Division of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye
| | - Anil Vasudevan
- Department of Pediatric Nephrology, St. John's Medical College Hospital, St. John's Academy of Health Sciences, Bengaluru, India
| | - Mignon McCulloch
- Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Upton Allen
- Division of Infectious Diseases and the Transplant and Regenerative Medicine Center, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Guido Filler
- Department of Paediatrics, Children's Hospital, London Health Science Centre, Western University, 800 Commissioners Road East, London, ON, N6A 5W9, Canada
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
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3
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Yuan Q, Shen Z, Li Z. Research Progress in Pediatric Lung Transplantation: A Bibliometric Analysis. Thorac Cardiovasc Surg 2025. [PMID: 40306662 DOI: 10.1055/a-2572-6428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2025]
Abstract
Pediatric lung transplantation is considered to be an effective treatment for end-stage lung disease in children, and this study mainly conducts a bibliometric analysis in the field of pediatric lung transplantation.We used the web of science databases to perform a bibliometric analysis of the progress of research in the field of pediatric lung transplantation from 1996 to 2024. In addition, we used VOSviewer software and the "bibliometrix" package in R to visualize and analyze the authors, countries, journals, institutions, and keywords of the literature.We identified 359 literature studies related to pediatric lung transplantation, which were cited 6,387 times by 1,400 journals. The journal with the highest number of average citations was the "New England Journal of Medicine," while the journals with the highest number of publications were the "Journal of Heart and Lung Transplantation and Pediatric Transplantation." The United States was the country with the highest number of publications (64.3%), followed by the United Kingdom (11.1%) and Canada (8.08%).Research in the field of pediatric lung transplantation is currently on the rise, while research is still dominated by developed countries, with most developing countries in their infancy. Against the background of COVID-19 and global health challenges, the unique need for pediatric lung transplantation is becoming a trend.
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Affiliation(s)
- Quan Yuan
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zixiong Shen
- The First Hospital of Jilin University, Changchun, Jilin, China
| | - Zhiqin Li
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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4
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Alparslan C, Malyszko J, Caskey FJ, Aleckovic-Halilovic M, Hrušková Z, Arruebo S, Bello AK, Damster S, Donner JA, Jha V, Johnson DW, Levin A, Malik C, Nangaku M, Okpechi IG, Tonelli M, Ye F, Tesar V, Racki S. Capacity for the management of kidney failure in the International Society of Nephrology Eastern and Central Europe region: report from the 2023 ISN Global Kidney Health Atlas (ISN-GKHA). Kidney Int Suppl (2011) 2024; 13:29-42. [PMID: 38618499 PMCID: PMC11010604 DOI: 10.1016/j.kisu.2024.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 04/16/2024] Open
Abstract
Delivery of care for kidney failure (KF) globally has a significant disparity; even in some countries, it means end of life for the person. The International Society of Nephrology Global Kidney Health Atlas (ISN-GKHA) tries to address gaps in KF care and standardize global nephrology care. From the third iteration of the ISN-GKHA, we present data for countries in the ISN Eastern and Central Europe region. The median prevalences of chronic kidney disease (12.8%) and treated KF (873.5 pmp) were higher than the global rates, respectively. Hemodialysis was the most preferred modality for KF in adults, whereas kidney replacement therapy was more balanced in children. Although most of the countries in the region had lower-middle-income and upper-middle-income levels, health expenditures for kidney health care were almost generally covered publicly. Nephrologists were responsible for the medical kidney care of people with KF in all countries. There was adequate infrastructure to provide all kinds of treatment for kidney care in the region. Regional characteristics such as high levels of obesity, smoking, and Balkan nephropathy as an endemic disease coupled with a shortage of workforce and finance continued to affect kidney care in the region negatively. By making organizational and legislative arrangements, partnerships with national authorities and societies may accelerate the improvement of kidney health care in the region.
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Affiliation(s)
- Caner Alparslan
- Department of Pediatric Nephrology, İzmir Democracy University School of Medicine, İzmir, Turkey
| | - Jolanta Malyszko
- Department of Nephrology, Dialysis and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Fergus J. Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mirna Aleckovic-Halilovic
- Clinic for Internal Diseases, Department of Nephrology, Dialysis and Transplantation, University Hospital Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Zdenka Hrušková
- Department of Nephrology, First Faculty of Medicine, Charles University and General Hospital in Prague, Prague, Czech Republic
| | - Silvia Arruebo
- The International Society of Nephrology, Brussels, Belgium
| | - Aminu K. Bello
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jo-Ann Donner
- The International Society of Nephrology, Brussels, Belgium
| | - Vivekanand Jha
- George Institute for Global Health, University of New South Wales, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Manipal Academy of Higher Education, Manipal, India
| | - David W. Johnson
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network at the University of Queensland, Brisbane, Queensland, Australia
| | - Adeera Levin
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charu Malik
- The International Society of Nephrology, Brussels, Belgium
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Ikechi G. Okpechi
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Marcello Tonelli
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Canada and Pan-American Health Organization/World Health Organization’s Collaborating Centre in Prevention and Control of Chronic Kidney Disease, University of Calgary, Calgary, Alberta, Canada
| | - Feng Ye
- Division of Nephrology and Immunology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Vladimir Tesar
- Department of Nephrology, First Faculty of Medicine, Charles University and General Hospital in Prague, Prague, Czech Republic
| | - Sanjin Racki
- Department of Nephrology, Dialysis and Transplantation, University Hospital Center Rijeka, Rijeka, Croatia
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Bitar R, Elghoudi AA, Rawat D, Azaz A, Miqdady M, Narchi H. COVID-19-induced liver injury in infants, children, and adolescents. World J Clin Pediatr 2023; 12:57-67. [PMID: 37342451 PMCID: PMC10278079 DOI: 10.5409/wjcp.v12.i3.57] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/07/2022] [Accepted: 03/17/2023] [Indexed: 06/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) typically presents with fever and respiratory symptoms in children. Most children develop an asymptomatic and mild illness, with a minority requiring specialist medical care. Gastrointestinal manifestations and liver injury can also occur in children following infection. The mechanisms of liver injury may include infection following direct viral hepatic tissue invasion, immune response, or medication effects. Affected children might develop mild liver dysfunction which has a benign course in most children with no pre-existing liver disease. However, the presence of non-alcoholic fatty liver disease or other pre-existing chronic liver disorders is associated with a higher risk of developing severe COVID-19 illness with poor outcomes. On the other hand, the presence of liver manifestations is associated with the severity of COVID-19 disease and is considered an independent prognostic factor. Respiratory, hemodynamic, and nutritional supportive therapies are the mainstay of management. Vaccination of children at increased risk of developing severe COVID-19 disease is indicated. This review describes the liver manifestations in children with COVID-19, detailing its epidemiology, basic mechanisms, clinical expression, management, and prognosis in those with and without pre-existing liver disease and also children who have had earlier liver transplantation.
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Affiliation(s)
- Rana Bitar
- Division of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Ahmed A Elghoudi
- Department of Pediatric, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- Department of Pediatric, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - David Rawat
- Division of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Amer Azaz
- Division of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Mohamad Miqdady
- Division of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
| | - Hassib Narchi
- Department of Pediatric, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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6
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Manoel MNF, Santos SP, Amado CAF. Assessing the impact of COVID-19 on the performance of organ transplant services using data envelopment analysis. Health Care Manag Sci 2023:10.1007/s10729-023-09637-4. [PMID: 37099041 PMCID: PMC10130802 DOI: 10.1007/s10729-023-09637-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 03/23/2023] [Indexed: 04/27/2023]
Abstract
Organ transplant is one of the best options for many medical conditions, and in many cases, it may be the only treatment option. Recent evidence suggests, however, that the COVID-19 pandemic might have detrimentally affected the provision of this type of healthcare services. The main purpose of this article is to use Data Envelopment Analysis and the Malmquist Index to assess the impact that the pandemic caused by the novel coronavirus SARS-CoV-2 had on the provision of solid organ transplant services. To this purpose, we use three complementary models, each focusing on specific aspects of the organ donation and transplantation process, and data from Brazil, which has one of the most extensive public organ transplant programs in the world. Using data from 17 States plus the Federal District, the results of our analysis show a significant drop in the performance of the services in terms of the organ donation and transplantation process from 2018 to 2020, but the results also indicate that not all aspects of the process and States were equally affected. Furthermore, by using different models, this research also allows us to gain a more comprehensive and informative assessment of the performance of the States in delivering this type of service and identify opportunities for reciprocal learning, expanding our knowledge on this important issue and offering opportunities for further research.
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Affiliation(s)
- Márcia N F Manoel
- Faculty of Economics and Center for Advanced Studies in Management and Economics, University of Algarve, Faro, Portugal
| | - Sérgio P Santos
- Faculty of Economics and Center for Advanced Studies in Management and Economics, University of Algarve, Faro, Portugal.
| | - Carla A F Amado
- Faculty of Economics and Center for Advanced Studies in Management and Economics, University of Algarve, Faro, Portugal
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7
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León AGD, Gil-Flores L, Colunga-Pedraza P, Bourlon C, Vargas-Serafín C, del Campo-Martínez MDLÁ, Olaya-Vargas A, Pérez-García M, González-Leal XJ, Herrera Rojas MA, Lozano-Rodríguez S, Solano-Genesta M, Rodríguez-Zúñiga AC, Sánchez-Arteaga A, Ruiz-Argüelles GJ, Gómez-Almaguer D. Hematopoietic stem cell transplantation activity in Mexico during the COVID19 pandemic: on the way to recovery. Hematology 2022; 27:1294-1300. [DOI: 10.1080/16078454.2022.2156737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Andrés Gómez-De León
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Lourdes Gil-Flores
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Perla Colunga-Pedraza
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Christianne Bourlon
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - César Vargas-Serafín
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | - Xitlaly J. González-Leal
- Instituto Tecnológico de Estudios Superiores de Monterrey. Monterrey Nuevo León.S, Monterrey, Mexico
- Clínica Gómez-Almaguer, Monterrey
| | | | - Sergio Lozano-Rodríguez
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | | | - Anna Cecilia Rodríguez-Zúñiga
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | - Alexia Sánchez-Arteaga
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
| | | | - David Gómez-Almaguer
- Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario Dr. José Eleuterio González, Monterrey, Mexico
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Yazıcıoğlu B, Bakkaloğlu SA. Impact of coronavirus disease-2019 on pediatric nephrology practice and education: an ESPN survey. Pediatr Nephrol 2022; 37:1867-1875. [PMID: 34971403 PMCID: PMC8929721 DOI: 10.1007/s00467-021-05226-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19) has been challenging for patients and medical staff. Radical changes have been needed to prevent disruptions in patient care and medical education. METHODS A web-based survey was sent to European Society for Pediatric Nephrology (ESPN) members via the ESPN mailing list to evaluate the effects of the COVID-19 pandemic on delivery of pediatric nephrology (PN) care and educational activities. There were ten questions with subheadings. RESULTS Seventy-six centers from 24 countries completed the survey. The time period was between the beginning of the pandemic and May 30, 2020. The number of patients admitted in PN wards and outpatient clinics were significantly decreased (2.2 and 4.5 times, respectively). Telemedicine tools, electronic prescriptions, online applications for off-label drugs, and remote access to laboratory/imaging results were used in almost half of the centers. Despite staff training and protective measures, 33% of centers reported COVID-19 infected staff, and 29% infected patients. Difficulties in receiving pharmaceuticals were reported in 25% of centers. Sixty percent of centers suspended living-related kidney transplantation, and one-third deceased-donor kidney transplantation. Hands-on education was suspended in 91% of medical schools, and face-to-face teaching was replaced by online systems in 85%. Multidisciplinary training in PN was affected in 54% of the centers. CONCLUSIONS This survey showed a sharp decline in patient admissions and a significant decrease in kidney transplantation. Telemedicine and online teaching became essential tools, requiring integration into the current system. The prolonged and fluctuating course of the pandemic may pose additional challenges necessitating urgent and rational solutions.
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Affiliation(s)
- Burcu Yazıcıoğlu
- Department of Pediatric Nephrology, Gazi University School of Medicine, Ankara, Turkey
| | - Sevcan A Bakkaloğlu
- Department of Pediatric Nephrology, Gazi University School of Medicine, Ankara, Turkey.
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9
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LEVENTOĞLU E, ÖZDEMİR ATİKEL Y, NALÇACIOĞLU H, DURSUN İ, DURSUN H, YÜRÜK YILDIRIM Z, YILDIZ N, KAYA AKSOY G, TAŞDEMİR M, ÇELAKIL M, DEMİRCİOĞLU KILIÇ B, ZIRHLI SELÇUK Ş, CANPOLAT N, KARGIN ÇAKICI E, ÖZLÜ SG, TÜLPAR S, YÜKSEL S, ATMIŞ B, SÜRMELİ DÖVEN S, TANER S, ERTAN P, KAVAZ A, TORUN BAYRAM M, KALYONCU M, GÜLLEROĞLU K, KABASAKAL C, KASAP DEMİR B, ÇİÇEK RY, BİLGE I, DÖNMEZ O, KARA A, YAVAŞCAN Ö, ÖZÇELİK G, GEZGİN YILDIRIM D, GÜLER MA, SÖNMEZ F, POYRAZOĞLU H, AKMAN S, TOPALOĞLU R, ALPAY H, BAKKALOĞLU SA. COVID-19 in pediatric nephrology centers in Turkey. Turk J Med Sci 2022; 52:1762-1770. [PMID: 36945974 PMCID: PMC10390129 DOI: 10.55730/1300-0144.5521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/21/2022] [Accepted: 07/24/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND/AIM There is limited data on COVID-19 disease in children with kidney disease. We aimed to investigate the characteristics and prognosis of COVID-19 in pediatric nephrology patients in Turkey. MATERIALS AND METHODS This was a national, multicenter, retrospective cohort study based on an online survey evaluating the data between 11th March 2020 and 11th March 2021 as an initial step of a detailed pediatric nephrology COVID-19 registry. RESULTS Two hundred and three patients (89 girls and 114 boys) were diagnosed with COVID-19. One-third of these patients (36.9%) were between 10-15 years old. Half of the patients were on kidney replacement therapy: kidney transplant (KTx) recipients (n = 56, 27.5%), patients receiving chronic hemodialysis (n = 33, 16.3%) and those on peritoneal dialysis (PD) (n = 18, 8.9%). Fifty-four (26.6%) children were asymptomatic. Eighty-two (40.3%) patients were hospitalized and 23 (28%) needed intensive care unit admission. Fifty-five percent of the patients were not treated, while the remaining was given favipiravir (20.7%), steroid (16.3%), and hydroxychloroquine (11.3%). Acute kidney injury developed in 19.5% of hospitalized patients. Five (2.4%) had MIS-C. Eighty-three percent of the patients were discharged without any apparent sequelae, while 7 (3.4%) died. One hundred and eight health care staff were infected during the study period. CONCLUSION COVID-19 was most commonly seen in patients who underwent KTx and received HD. The combined immunosuppressive therapy and frequent exposure to the hospital setting may increase these patients' susceptibility. Staff infections before vaccination era were alarming, various precautions should be taken for infection control, particularly optimal vaccination coverage.
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Affiliation(s)
- Emre LEVENTOĞLU
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Gazi University, Ankara,
Turkey
| | - Yeşim ÖZDEMİR ATİKEL
- Department of Pediatric Nephrology, Eskişehir City Training and Research Hospital, Eskişehir,
Turkey
| | - Hülya NALÇACIOĞLU
- Department of Pediatric Nephrology, Faculty of Medicine, Ondokuz Mayıs University, Samsun,
Turkey
| | - İsmail DURSUN
- Department of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri,
Turkey
| | - Hasan DURSUN
- Department of Pediatric Nephrology, Prof. Dr. Cemil Taşçıoğlu City Hospital, University of Health Sciences, İstanbul,
Turkey
| | - Zeynep YÜRÜK YILDIRIM
- Department of Pediatric Nephrology, İstanbul Faculty of Medicine, İstanbul University, İstanbul,
Turkey
| | - Nurdan YILDIZ
- Department of Pediatric Nephrology, İstanbul Pendik Education and Research Hospital, Marmara University, İstanbul,
Turkey
| | - Gülşah KAYA AKSOY
- Department of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya,
Turkey
| | - Mehmet TAŞDEMİR
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Koç University, İstanbul,
Turkey
| | - Mehtap ÇELAKIL
- Department of Pediatric Nephrology, Hatay State Hospital, Hatay,
Turkey
| | | | - Şenay ZIRHLI SELÇUK
- Department of Pediatric Nephrology, Turgut Özal Medical Center, İnönü University, Malatya,
Turkey
| | - Nur CANPOLAT
- Department of Pediatric Nephrology, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul,
Turkey
| | - Evrim KARGIN ÇAKICI
- Department of Pediatric Nephrology, Dr. Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara,
Turkey
| | - Sare Gülfem ÖZLÜ
- Department of Pediatric Nephrology, Ankara City Training and Research Hospital, Ankara,
Turkey
| | - Sebahat TÜLPAR
- Department of Pediatric Nephrology, İstanbul Bakırköy Dr. Sadi Konuk Research and Training Hospital, University of Health Sciences, İstanbul,
Turkey
| | - Selçuk YÜKSEL
- Department of Pediatric Nephrology, Faculty of Medicine, Pamukkale University, Denizli,
Turkey
| | - Bahriye ATMIŞ
- Department of Pediatric Nephrology, Faculty of Medicine, Çukurova University, Adana,
Turkey
| | - Serra SÜRMELİ DÖVEN
- Department of Pediatric Nephrology, Faculty of Medicine, Mersin University, Mersin,
Turkey
| | - Sevgin TANER
- Department of Pediatric Nephrology, Adana City Training and Research Hospital, University of Health Sciences, Adana,
Turkey
| | - Pelin ERTAN
- Department of Pediatric Nephrology, Faculty of Medicine, Celal Bayar University, Manisa,
Turkey
| | - Aslı KAVAZ
- Department of Pediatric Nephrology, Faculty of Medicine, Osmangazi University, Eskişehir,
Turkey
| | - Meral TORUN BAYRAM
- Department of Pediatric Nephrology, Faculty of Medicine, Dokuz Eylül University, İzmir,
Turkey
| | - Mukaddes KALYONCU
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Karadeniz Technical University, Trabzon,
Turkey
| | - Kaan GÜLLEROĞLU
- Department of Pediatric Nephrology, Faculty of Medicine, Başkent University, Ankara,
Turkey
| | - Caner KABASAKAL
- Department of Pediatric Nephrology, Faculty of Medicine, Ege University, İzmir,
Turkey
| | - Belde KASAP DEMİR
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, İzmir Katip Çelebi University, İzmir,
Turkey
| | - Rümeysa Yasemin ÇİÇEK
- Department of Pediatric Nephrology, Başakşehir Çam and Sakura City Hospital, İstanbul,
Turkey
| | - Ilmay BİLGE
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Koç University, İstanbul,
Turkey
| | - Osman DÖNMEZ
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Uludağ University, Bursa,
Turkey
| | - Aslıhan KARA
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Fırat University, Elazığ,
Turkey
| | - Önder YAVAŞCAN
- Department of Pediatric Nephrology, Faculty of Medicine, Medipol University, İstanbul,
Turkey
| | - Gül ÖZÇELİK
- Department of Pediatric Nephrology, Şisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, İstanbul,
Turkey
| | - Deniz GEZGİN YILDIRIM
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Gazi University, Ankara,
Turkey
| | - Muhammet Akif GÜLER
- Department of Pediatric Nephrology, Faculty of Medicine, Atatürk University, Erzurum,
Turkey
| | - Ferah SÖNMEZ
- Department of Pediatric Nephrology, Faculty of Medicine, Adnan Menderes University, Aydın,
Turkey
| | - Hakan POYRAZOĞLU
- Department of Pediatric Nephrology, Faculty of Medicine, Erciyes University, Kayseri,
Turkey
| | - Sema AKMAN
- Department of Pediatric Nephrology, Faculty of Medicine, Akdeniz University, Antalya,
Turkey
| | - Rezan TOPALOĞLU
- Department of Pediatric Nephrology, Faculty of Medicine, Hacettepe University, Ankara,
Turkey
| | - Harika ALPAY
- Department of Pediatric Nephrology, İstanbul Pendik Education and Research Hospital, Marmara University, İstanbul,
Turkey
| | - Sevcan A. BAKKALOĞLU
- Departments of Pediatric Nephrology and Rheumatology, Faculty of Medicine, Gazi University, Ankara,
Turkey
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10
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George M, Thomas G, Karpelowsky J. Pediatric transplantation: An international perspective. Semin Pediatr Surg 2022; 31:151192. [PMID: 35725047 DOI: 10.1016/j.sempedsurg.2022.151192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The international practice of transplant in the pediatric population is heterogenous. Global trends in pediatric transplant activity are increasing, with diffusion of transplant activities into developing and emerging economies. There have been impacts of the COVID-19 pandemic which have in the earlier part of the pandemic caused a decrease in the number of transplants. While deceased donor programs are well established in advanced economies, emerging and developing countries rely heavily on live donor programs. Prioritization of organs for children exists in different forms throughout the world. Pediatric transplantation as a sub-specialty is young but growing around the world with a need to train surgeons and physicians in this discipline. Outreach efforts with multi-national and multi-institutional partnerships have enabled resource poor countries to establish new transplant programs for children. Further international collaboration, good quality data collection and audit, prospective research and ongoing mentorship and education are needed to further improve outcomes of all children receiving solid organ transplants.
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Affiliation(s)
- Mathew George
- Department of Surgery, Children's Hospital at Westmead, Australia
| | - Gordon Thomas
- Department of Surgery, Children's Hospital at Westmead, Division of Child and Adolescent Health, Sydney Medical School, University of Sydney, Australia
| | - Jonathan Karpelowsky
- Department of Surgery, Children's Hospital at Westmead, Children's Cancer Research Unit, Kids Research Institute, Division of Child and Adolescent Health, Sydney Medical School, University of Sydney, Westmead, NSW, Australia.
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11
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Kakos CD, Ziogas IA, Tsoulfas G. Pediatric transplantation during the COVID-19 pandemic. World J Transplant 2022; 12:88-99. [PMID: 35663540 PMCID: PMC9136715 DOI: 10.5500/wjt.v12.i5.88] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/16/2022] [Accepted: 04/20/2022] [Indexed: 02/06/2023] Open
Abstract
Children infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seem to have a better prognosis than adults. Nevertheless, pediatric solid organ transplantation (SOT) has been significantly affected by the unprecedented coronavirus disease 2019 (COVID-19) pandemic during the pre-, peri-, and post-transplant period. Undoubtedly, immunosuppression constitutes a real challenge for transplant clinicians as increased immunosuppression may prolong disease recovery, while its decrease can contribute to more severe symptoms. To date, most pediatric SOT recipients infected by SARS-CoV-2 experience mild disease with only scarce reports of life-threatening complications. As a consequence, after an initial drop during the early phase of the pandemic, pediatric SOTs are now performed with the same frequency as during the pre-pandemic period. This review summarizes the currently available evidence regarding pediatric SOT during the COVID-19 pandemic.
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Affiliation(s)
| | - Ioannis A Ziogas
- Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Georgios Tsoulfas
- Department of Transplantation Surgery, Aristotle University School of Medicine, Thessaloniki 54622, Greece
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12
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Impact of the COVID-19 pandemic on fertility preservation activities in France: a survey by the Groupe de Recherche et d'Etude sur la Conservation Ovarienne et Testiculaire (GRECOT; Group for Research and Studies on Ovarian and Testicular Preservation). J Gynecol Obstet Hum Reprod 2022; 51:102346. [DOI: 10.1016/j.jogoh.2022.102346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 02/08/2022] [Accepted: 02/24/2022] [Indexed: 11/19/2022]
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13
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Campagna BR, Tutino R, Stevanovic K, Flood J, Halevi G, Shemesh E, Annunziato RA. Acceleration of mobile health for monitoring post-transplant in the COVID-19 era: Applications for pediatric settings. Pediatr Transplant 2022; 26:e14152. [PMID: 34661316 PMCID: PMC8646582 DOI: 10.1111/petr.14152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Since the start of the COVID-19 pandemic and consequent lockdowns, the use of telehealth interventions has rapidly increased both in the general population and among transplant recipients. Among pediatric transplant recipients, this most frequently takes the form of interventions on mobile devices, or mHealth, such as remote visits via video chat or phone, phone-based monitoring, and mobile apps. Telehealth interventions may offer the opportunity to provide care that minimizes many of the barriers of in-person care. METHODS The present review followed the PRISMA guidelines. Sources up until October 2020 were initially identified through searches of PsycInfo® and PubMed® . RESULTS We identified ten papers that reported findings from adult interventions and five studies based in pediatrics. Eight of the adult publications stemmed from the same two trials; within the pediatric subset, this was the case for two papers. Studies that have looked at mHealth interventions have found high acceptability rates over the short run, but there is a general lack of data on long-term use. CONCLUSIONS The literature surrounding pediatric trials specifically is sparse with all findings referencing interventions that are in early stages of development, ranging from field tests to small feasibility trials. The lack of research highlights the need for a multi-center RCT that utilizes robust measures of medication adherence and other outcome variables, with longer-term follow-up before telehealth interventions should be fully embraced.
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Affiliation(s)
- Bianca R. Campagna
- Department of PsychologyFordham UniversityBronxNew YorkUSA,Department of PediatricsKravis Children’s HospitalIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Rebecca Tutino
- Department of PsychologyFordham UniversityBronxNew YorkUSA,Department of PediatricsKravis Children’s HospitalIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | | | - Julia Flood
- Department of PsychologyFordham UniversityBronxNew YorkUSA
| | - Gali Halevi
- Department of MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA,Department of Medical EducationIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Eyal Shemesh
- Department of PediatricsKravis Children’s HospitalIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Rachel A. Annunziato
- Department of PsychologyFordham UniversityBronxNew YorkUSA,Department of PediatricsKravis Children’s HospitalIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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14
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Mali VP, Aw M, Ng KH, Karthik SV, Tan M, Teo S, Lau PYW, Nyo YL, Loh DSKL, Tiong HY, Quak SH, Yap HK. Paediatric living-donor liver and kidney transplantation during COVID-19. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022; 51:119-121. [PMID: 35224610 DOI: 10.47102/annals-acadmedsg.2021272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- Vidyadhar Padmakar Mali
- Department of Paediatric Surgery, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
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15
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Musaoğlu M, Yuksel M, Mizikoglu O, Arikan C. Telemedicine in monitoring pediatric LT patients before and during COVID-19 pandemic. Pediatr Transplant 2022; 26:e14138. [PMID: 34505750 PMCID: PMC8646366 DOI: 10.1111/petr.14138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 08/18/2021] [Accepted: 08/29/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND The delivery of healthcare services by telemedicine decreases costs of traveling for patients, is less time-consuming, and most importantly permits the connection between highly skilled specialists and patients. However, whether the use of telemedicine (text messaging) for LT patients was affected by the COVID-19 pandemic is unknown. METHODS We collected data (following consent from patients and parents) from 57 patients (33 male/24 female) with a median age of 47 (IQR: 9-91) months, whom we followed up with text messaging between September 2019 and September 2020, spanning the 6 months prior to COVID-19 and during this period. RESULTS In total, 723 text message mediated consultations occurred during this period, henceforth simply referred to as "messages." Three hundred and twenty-eight (45%) messages occurred during the 6 months up to the start of the pandemic. Following the COVID-19 outbreak, the number of messages increased to 395 (55%). The three most common reasons of messaging were post-liver-LT follow-up messages (n = 215/723, 29.7%), consultations for drug use (n = 157/723, 21.7%), and medication prescriptions (n = 113/723, 15.6%). Protocol biopsy discussions (n = 33/723, 4.6%) and fever (n = 27/723, 3.7%) were among others (vaccination, rash, diarrhea, cough, fatigue, acne). During the COVID-19 outbreak, only post-LT follow-up messages increased significantly to 132/395 (33%) from 83/328 (25%) (p-value: .02). CONCLUSIONS We found that the pandemic resulted in an increase in the total number of text message mediated consultations and specifically for the use of post-LT follow-up. Messaging was effective for post-LT follow-ups and all patients were at least satisfied.
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Affiliation(s)
- Mirac Musaoğlu
- Koç UniversityPediatric Gastroenterology‐Hepatology/Liver Transplantation CenterIstanbulTurkey
| | - Muhammed Yuksel
- Koç UniversityPediatric Gastroenterology‐Hepatology/Liver Transplantation CenterIstanbulTurkey,Koç University Research Center for Translational Medicine (KUTTAM)‐Liver Immunology LabIstanbulTurkey
| | - Ozlem Mizikoglu
- Koç UniversityPediatric Gastroenterology‐Hepatology/Liver Transplantation CenterIstanbulTurkey
| | - Cigdem Arikan
- Koç UniversityPediatric Gastroenterology‐Hepatology/Liver Transplantation CenterIstanbulTurkey,Koç University Research Center for Translational Medicine (KUTTAM)‐Liver Immunology LabIstanbulTurkey
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16
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Bailey AJM, Kirkham AM, Monaghan M, Shorr R, Buchan CA, Bredeson C, Allan DS. A Portrait of SARS-CoV-2 Infection in Patients Undergoing Hematopoietic Cell Transplantation: A Systematic Review of the Literature. Curr Oncol 2022; 29:337-349. [PMID: 35049704 PMCID: PMC8774852 DOI: 10.3390/curroncol29010030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 12/15/2022] Open
Abstract
The management of COVID-19 in hematopoietic cell transplant (HCT) recipients represents a special challenge given the variable states of immune dysregulation and altered vaccine efficacy in this population. A systematic search (Ovid Medline and Embase on 1 June 2021) was needed to better understand the presenting features, prognostic factors, and treatment options. Of 897 records, 29 studies were identified in our search. Most studies reporting on adults and pediatric recipients described signs and symptoms that were typical of COVID-19. Overall, the mortality rates were high, with 21% of adults and 6% of pediatric HCT recipients succumbing to COVID-19. The factors reported to be associated with increased mortality included age (HR = 1.21, 95% CI 1.03-1.43, p = 0.02), ICU admission (HR = 4.42, 95% CI 2.25-8.65, p < 0.001 and HR = 2.26, 95% CI 1.22-4.20, p = 0.01 for allogeneic and autologous HCT recipients), and low platelet count (OR = 21.37, 95% CI 1.71-267.11, p = 0.01). Performance status was associated with decreased mortality (HR = 0.83, 95% CI 0.74-0.93, p = 0.001). A broad range of treatments was described, although no controlled studies were identified. The risk of bias, using the Newcastle-Ottawa scale, was low. Patients undergoing HCT are at a high risk of severe morbidity and mortality associated with COVID-19. Controlled studies investigating potential treatments are required to determine the efficacy and safety in this population.
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Affiliation(s)
- Adrian J. M. Bailey
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.J.M.B.); (A.M.K.); (C.A.B.); (C.B.)
| | - Aidan M. Kirkham
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.J.M.B.); (A.M.K.); (C.A.B.); (C.B.)
| | - Madeline Monaghan
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
| | - Risa Shorr
- Medical Library and Learning Services, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada;
| | - C. Arianne Buchan
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.J.M.B.); (A.M.K.); (C.A.B.); (C.B.)
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
- Division of Infectious Disease, Department of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Christopher Bredeson
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.J.M.B.); (A.M.K.); (C.A.B.); (C.B.)
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
- Transplant & Cellular Therapy in the Department of Medicine, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
| | - David S. Allan
- Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada; (A.J.M.B.); (A.M.K.); (C.A.B.); (C.B.)
- Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON K1H 8L6, Canada;
- Transplant & Cellular Therapy in the Department of Medicine, The Ottawa Hospital, Ottawa, ON K1H 8L6, Canada
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17
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Nicastro E, Ebel NH, Kehar M, Czubkowski P, Ng VL, Michaels MG, Lobritto SJ, Martinez M, Indolfi G. The Impact of Severe Acute Respiratory Syndrome Coronavirus Type 2 on Children With Liver Diseases: A Joint European Society for Pediatric Gastroenterology, Hepatology and Nutrition and Society of Pediatric Liver Transplantation Position Paper. J Pediatr Gastroenterol Nutr 2022; 74:159-170. [PMID: 34694269 PMCID: PMC8673661 DOI: 10.1097/mpg.0000000000003339] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 10/16/2021] [Indexed: 02/07/2023]
Abstract
ABSTRACT Children are seldom affected by severe forms of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV2) infection; however, the impact of comorbidities in the clinical presentation and outcome of SARS-CoV2 in children is poorly characterized including that of chronic liver disease (CLD) and those taking immunosuppressive medications for autoimmune liver disease or following liver transplantation (LT). Although not the main target organ, a spectrum of liver involvement has been described in children infected with SARS-CoV2 and those presenting with Multisystem Inflammatory Syndrome in Children (MIS-C). The Hepatology Committee of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and the Society of Pediatric Liver Transplantation (SPLIT) present an evidence-based position paper on liver involvement in children with SARS-CoV2 infection and its impact on those with CLD as well as LT recipients. All children may exhibit acute liver injury from SARS-CoV2 infection, and those with CLD and may experience hepatic decompensation. Preventative and therapeutic measures are discussed.
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Affiliation(s)
- Emanuele Nicastro
- Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Noelle H. Ebel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Mohit Kehar
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Piotr Czubkowski
- Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Vicky L. Ng
- Division of Gastroenterology, Hepatology, and Nutrition, the Hospital for Sick Children, Toronto, ON, Canada
| | - Marian G. Michaels
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Pittsburgh, School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Steven J. Lobritto
- Liver Unit, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Irving Medical Center Morgan Stanley Children's Hospital, New York, NY
| | - Mercedes Martinez
- Liver Unit, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Columbia University Irving Medical Center Morgan Stanley Children's Hospital, New York, NY
| | - Giuseppe Indolfi
- Meyer Children's University Hospital, Department NEUROFARBA, University of Florence, Firenze, Italy
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18
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Impact of Technologic Innovation and COVID-19 Pandemic on Pediatric Cardiology Telehealth. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2022; 8:309-324. [PMID: 36479525 PMCID: PMC9510217 DOI: 10.1007/s40746-022-00258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 12/14/2022]
Abstract
Purpose of Review Established telehealth practices in pediatrics and pediatric cardiology are evolving rapidly. This review examines several concepts in contemporary telemedicine in our field: recent changes in direct-to-consumer (DTC) pediatric telehealth (TH) and practice based on lessons learned from the pandemic, scientific data from newer technological innovations in pediatric cardiology, and how TH is shaping global pediatric cardiology practice. Recent Findings In 2020, the global pandemic of COVID-19 led to significant changes in healthcare delivery. The lockdown and social distancing guidelines accelerated smart adaptations and pivots to ensure continued pediatric care albeit in a virtual manner. Remote cardiac monitoring technology is continuing to advance at a rapid pace secondary to advances in the areas of Internet access, portable hand-held devices, and artificial intelligence. Summary TH should be approached programmatically by pediatric cardiac healthcare providers with careful selection of patients, technology platforms, infrastructure setup, documentation, and compliance. Payment parity with in-person visits should be advocated and legislated. Newer remote cardiac monitoring technology should be expanded for objective assessment and optimal outcomes. TH continues to be working beyond geographical boundaries in pediatric cardiology and should continue to expand and develop.
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19
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Talgam-Horshi E, Mozer-Glassberg Y, Waisbourd-Zinman O, Ashkenazi-Hoffnung L, Haskin O, Levi S, Hamdani G, Landau D, Alfandary H. Clinical Outcomes and Antibody Response in COVID-19-Positive Pediatric Solid Organ Transplant Recipients. Pediatr Infect Dis J 2021; 40:e514-e516. [PMID: 34382612 PMCID: PMC8575083 DOI: 10.1097/inf.0000000000003293] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 12/27/2022]
Abstract
We describe the clinical and laboratory manifestations and outcomes of 25 pediatric solid organ transplant recipients who tested positive for severe acute respiratory coronavirus-2. Twenty-one (84%) developed a mild disease; 22 of 23 (96%) had a positive serologic response. Two patients (8%), both kidney transplant recipients with additional comorbidities, developed a severe disease. The findings emphasize the need for close monitoring of this population.
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Affiliation(s)
- Efrat Talgam-Horshi
- From the Department of Pediatrics, Assuta Ashdod University Hospital, Ashdod, Israel
| | - Yael Mozer-Glassberg
- From the Department of Pediatrics, Assuta Ashdod University Hospital, Ashdod, Israel
- Institute of Gastroenterology, Nutrition, and Liver Disease
| | - Orit Waisbourd-Zinman
- From the Department of Pediatrics, Assuta Ashdod University Hospital, Ashdod, Israel
- Institute of Gastroenterology, Nutrition, and Liver Disease
| | - Liat Ashkenazi-Hoffnung
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Day Hospitalization Department
- Pediatric Infectious Diseases Unit
| | - Orly Haskin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Shelly Levi
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Gilad Hamdani
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Daniel Landau
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Hadas Alfandary
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Institute of Nephrology, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
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20
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Abstract
Pediatric gastroenterologists took on a variety of challenges during the coronavirus disease 2019 pandemic, including learning about a new disease and how to recognize and manage it, prevent its spread among their patients and health professions colleagues, and make decisions about managing patients with chronic gastrointestinal and liver problems in light of the threat. They adapted their practice to accommodate drastically decreased numbers of in-person visits, adopting telehealth technologies, and instituting new protocols to perform endoscopies safely. The workforce pipeline was also affected by the impact of the pandemic on trainee education, clinical experience, research, and job searches.
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Affiliation(s)
- Richard Taylor
- Pediatric Residency Program, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 5018, Cincinnati, OH 45229, USA
| | - Daniel Mallon
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2010, Cincinnati, OH 45229, USA.
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21
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Jaime‐Pérez JC, González‐Treviño M, Meléndez‐Flores JD, Ramos‐Dávila EM, Colunga‐Pedraza JE, Colunga‐Pedraza PR, Jiménez‐Antolinez V, Gómez‐Almaguer D. Safety and feasibility of outpatient hematopoietic cell transplantation in pediatric patients during the COVID-19 pandemic: A single-center experience. Pediatr Blood Cancer 2021; 68:e29252. [PMID: 34291876 PMCID: PMC8441788 DOI: 10.1002/pbc.29252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/11/2021] [Indexed: 11/11/2022]
Affiliation(s)
- José Carlos Jaime‐Pérez
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Mariana González‐Treviño
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Jesús D. Meléndez‐Flores
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Eugenia M. Ramos‐Dávila
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Julia E. Colunga‐Pedraza
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Perla R. Colunga‐Pedraza
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - Valentine Jiménez‐Antolinez
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
| | - David Gómez‐Almaguer
- Hematology Service, Internal Medicine Division“Dr. José Eleuterio González” University Hospital and School of Medicine, Universidad Autónoma de Nuevo LeónMonterreyMéxico
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23
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Barie PS, Ho VP, Hunter CJ, Kaufman EJ, Narayan M, Pieracci FM, Schubl SD, Heffernan DS, Huston JM. Surgical Infection Society Guidance for Restoration of Surgical Services during the Coronavirus Disease-2019 Pandemic. Surg Infect (Larchmt) 2021; 22:818-827. [PMID: 33635145 PMCID: PMC8591060 DOI: 10.1089/sur.2020.421] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: As the coronavirus disease-2019 (COVID-19) pandemic continues globally, high numbers of new infections are developing nationwide, particularly in the U.S. Midwest and along both the Atlantic and Pacific coasts. The need to accommodate growing numbers of hospitalized patients has led facilities in affected areas to suspend anew or curtail normal hospital activities, including elective surgery, even as earlier-affected areas normalized surgical services. Backlogged surgical cases now number in the tens of millions globally. Facilities will be hard-pressed to address these backlogs, even absent the recrudescence of COVID-19. This document provides guidance for the safe and effective resumption of surgical services as circumstances permit. Methods: Review and synthesis of pertinent international peer-reviewed literature, with integration of expert opinion. Results: The "second-wave" of serious infections is placing the healthcare system under renewed stress. Surgical teams likely will encounter persons harboring the virus, whether symptomatic or not. Continued vigilance and protection of patients and staff remain paramount. Reviewed are the impact of COVID-19 on the surgical workforce, considerations for operating on a COVID-19 patient and the outcomes of such operations, the size and nature of the surgical backlog, and the logistics of resumption, including organizational considerations, patient and staff safety, preparation of the surgical candidate, and the role of enhanced recovery programs to reduce morbidity, length of stay, and cost by rational, equitable resource utilization. Conclusions: Resumption of surgical services requires institutional commitment (including teams of surgeons, anesthesiologists, nurses, pharmacists, therapists, dieticians, and administrators). Structured protocols and equitable implementation programs, and iterative audit, planning, and integration will improve outcomes, enhance safety, preserve resources, and reduce cost, all of which will contribute to safe and successful reduction of the surgical backlog.
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Affiliation(s)
- Philip S. Barie
- Departments of Surgery and Weill Cornell Medicine, New York, New York, USA
- Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Vanessa P. Ho
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Catherine J. Hunter
- Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | | | - Mayur Narayan
- Departments of Surgery and Weill Cornell Medicine, New York, New York, USA
| | - Fredric M. Pieracci
- Department of Surgery, DenverHealth Medical Center, University of Colorado Anschutz School of Medicine, Denver, Colorado, USA
| | - Sebastian D. Schubl
- Department of Surgery, University of California-Irvine, Orange, California, USA
| | - Daithi S. Heffernan
- Department of Surgery, Providence Veterans Affairs Medical Center, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jared M. Huston
- Departments of Surgery and Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
- Science Education, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
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24
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Alnagar A, Ruth N, Elsharif M, Bici K, Shawky A, Kelly D, Attia M. Paediatric Liver Transplantation During COVID-19 Pandemic: Lessons Learned and Unanswered Questions. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:2229-2236. [PMID: 34568760 PMCID: PMC8453461 DOI: 10.1007/s42399-021-01050-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/04/2022]
Abstract
COVID-19 pandemic has imposed many challenges on paediatric liver transplantation (PLT) services and has necessitated several adaptations in different stages of the process to ensure transplant centres can still deliver the proposed services in addition to protecting patients and staff against infection. This review article digs through the current literature to clarify the challenges imposed by SARS-CoV2 on PLT centres globally. It provides an overview of current practice as well as suggestions from experts in the field to overcome multiple obstacles. In paediatrics, the reaction to SARS-CoV2 may be less severe than that seen in the adult population, but this can change in view of newly discovered virus strains. Response of transplant centres to the current pandemic was variable depending on the anticipated risk and available resources. Telemedicine has helped PLT programmes to continue their activities while protecting patients, as well as staff against the risk of SARS-CoV2 virus. Further studies are needed to guide immunosuppression management in post-transplant infected candidates; answering this critical question will help PLT centres solve this dilemma.
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Affiliation(s)
- Amr Alnagar
- The Leeds Teaching Hospitals, NHS Foundation Trust, Centre-Beckett Street, LS9 7TF Leeds City, UK.,General Surgery Department, Faculty of Medicine, Alexandria University, Khartoom Square, Azareeta, Alexandria Egypt
| | - Nicola Ruth
- Liver Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK.,University of Birmingham, Birmingham, UK
| | - Mohamed Elsharif
- The Leeds Teaching Hospitals, NHS Foundation Trust, Centre-Beckett Street, LS9 7TF Leeds City, UK
| | - Kejd Bici
- Meyer Chi, ldren's Hospital, University of Florence, Florence, Italy
| | - Ahmed Shawky
- General Surgery Department, Faculty of Medicine, Alexandria University, Khartoom Square, Azareeta, Alexandria Egypt
| | - Deirdre Kelly
- Meyer Chi, ldren's Hospital, University of Florence, Florence, Italy.,University of Birmingham, Birmingham, UK
| | - Magdy Attia
- The Leeds Teaching Hospitals, NHS Foundation Trust, Centre-Beckett Street, LS9 7TF Leeds City, UK
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25
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Bašković M. The impact of telemedicine on the quality and satisfaction with the health care provided during the COVID-19 pandemic in the field of pediatrics with special reference to the surgical professions. POLISH JOURNAL OF SURGERY 2021; 93:53-60. [DOI: 10.5604/01.3001.0015.2649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The COVID-19 pandemic has forced healthcare systems around the world to adopt telemedicine at an unprecedented rate.
Visits to telemedicine have increased to provide access and maintain continuity of care. Internet access has almost become
a necessity, and new technologies allow for the easy flow of data from patient to doctor and vice versa. Doctors of all specialties
were forced to adapt to the pandemic and emerging conditions. The provision of surgical services and the learning ability of
surgeons are particularly disrupted, and the pediatric surgical community is not exempt. During the pandemic, telemedicine
proved to be a viable and safe technique for providing health services. In an environment of a health system that is constantly
facing a shortage of resources, effective telemedicine placement can come with a high benefit-cost ratio and quality of care,
while ensuring patient satisfaction.
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Affiliation(s)
- Marko Bašković
- Department of Pediatric Surgery, Children's Hospital Zagreb, Croatia
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26
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Alfishawy M, Nso N, Nassar M, Ariyaratnam J, Bhuiyan S, Siddiqui RS, Li M, Chung H, Al Balakosy A, Alqassieh A, Fülöp T, Rizzo V, Daoud A, Soliman KM. Liver transplantation during global COVID-19 pandemic. World J Clin Cases 2021; 9:6608-6623. [PMID: 34447809 PMCID: PMC8362541 DOI: 10.12998/wjcc.v9.i23.6608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 06/02/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory disease respiratory syndrome coronavirus-2 has significantly impacted the health care systems globally. Liver transplantation (LT) has faced an unequivocal challenge during this unprecedented time. This targeted review aims to cover most of the clinical issues, challenges and concerns about LT during the COVID-19 pandemic and discuss the most updated literature on this rapidly emerging subject.
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Affiliation(s)
- Mostafa Alfishawy
- Infectious Diseases, Infectious Diseases Consultants and Academic Researchers of Egypt IDCARE, Cairo 0000, Egypt
| | - Nso Nso
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Mahmoud Nassar
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Jonathan Ariyaratnam
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Sakil Bhuiyan
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Raheel S Siddiqui
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Matthew Li
- Clinical pharmacy department, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Howard Chung
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Amira Al Balakosy
- Tropical Medicine Department, Ain Shams University, Cairo 11517, Egypt
| | - Ahmed Alqassieh
- Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Tibor Fülöp
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Vincent Rizzo
- Department of Medicine, Icahn School of Medicine at Mount Sinai (NYC Health and Hospitals: Queens), New York, NY 11373, United States
| | - Ahmed Daoud
- Department of Medicine, Kasr Alainy Medical School, Cairo University, Cairo 11562, Egypt
| | - Karim M Soliman
- Department of Medicine, Medical University of South Carolina, Charleston, SC 29425, United States
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27
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L’Huillier AG, Danziger‐Isakov L, Chaudhuri A, Green M, Michaels MG, M Posfay‐Barbe K, van der Linden D, Verma A, McCulloch M, Ardura MI. SARS-CoV-2 and pediatric solid organ transplantation: Current knowns and unknowns. Pediatr Transplant 2021; 25:e13986. [PMID: 33689201 PMCID: PMC8237081 DOI: 10.1111/petr.13986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/17/2021] [Accepted: 02/02/2021] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic has proven to be a challenge in regard to the clinical presentation, prevention, diagnosis, and management of SARS-CoV-2 infection among children who are candidates for and recipients of SOT. By providing scenarios and frequently asked questions encountered in routine clinical practice, this document provides expert opinion and summarizes the available data regarding the prevention, diagnosis, and management of SARS-CoV-2 infection among pediatric SOT candidates and recipients and highlights ongoing knowledge gaps requiring further study. Currently available data are still lacking in the pediatric SOT population, but data have emerged in both the adult SOT and general pediatric population regarding the approach to COVID-19. The document provides expert opinion regarding prevention, diagnosis, and management of SARS-CoV-2 infection among pediatric SOT candidates and recipients.
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Affiliation(s)
- Arnaud G. L’Huillier
- Pediatric Infectious Diseases UnitGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
| | | | | | - Michael Green
- UPMC Children’s Hospital of PittsburghPittsburghPAUSA
| | | | - Klara M Posfay‐Barbe
- Pediatric Infectious Diseases UnitGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
| | - Dimitri van der Linden
- Pediatric Infectious DiseasesDepartment of PediatricsCliniques Universitaires Saint‐LucBrusselsBelgium
| | | | | | - Monica I. Ardura
- Department of Pediatrics, Infectious Diseases and Host DefenseNationwide Children’s HospitalThe Ohio State UniversityColumbusOHUSA
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28
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Faria BCD, Sacramento LGG, Filipin CSA, da Cruz AF, Nagata SN, Silva ACSE. An analysis of chronic kidney disease as a prognostic factor in pediatric cases of COVID-19. J Bras Nefrol 2021; 43:400-409. [PMID: 33704348 PMCID: PMC8428649 DOI: 10.1590/2175-8239-jbn-2020-0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 12/17/2020] [Indexed: 11/24/2022] Open
Abstract
Advanced age is a risk factor for severe infection by acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Children, however, often present with milder manifestations of Coronavirus Disease 2019 (COVID-19). Associations have been found between COVID-19 and multisystem inflammatory syndrome in children (MIS-C). Patients with the latter condition present more severe involvement. Adults with comorbidities such as chronic kidney disease (CKD) are more severely affected. This narrative review aimed to look into whether CKD contributed to more severe involvement in pediatric patients with COVID-19. The studies included in this review did not report severe cases or deaths, and indicated that pediatric patients with CKD and previously healthy children recovered quickly from infection. However, some patients with MIS-C required hospitalization in intensive care units and a few died, although it was not possible to correlate MIS-C and CKD. Conversely, adults with CKD reportedly had increased risk of severe infection by SARS-CoV-2 and higher death rates. The discrepancies seen between age groups may be due to immune system and renin-angiotensin system differences, with more pronounced expression of ACE2 in children. Immunosuppressant therapy has not been related with positive or negative effects in individuals with COVID-19, although current recommendations establish decreases in the dosage of some medications. To sum up with, CKD was not associated with more severe involvement in children diagnosed with COVID-19. Studies enrolling larger populations are still required.
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Affiliation(s)
| | | | | | - Aniel Feitosa da Cruz
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo
Horizonte, MG, Brasil
| | - Sarah Naomi Nagata
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Belo
Horizonte, MG, Brasil
| | - Ana Cristina Simões e Silva
- Universidade Federal de Minas Gerais, Faculdade de Medicina,
Departamento de Pediatria, Belo Horizonte, MG, Brasil
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29
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Calitri C, Fumi I, Ignaccolo MG, Banino E, Benetti S, Lupica MM, Fantone F, Pace M, Garofalo F. Gastrointestinal involvement in paediatric COVID-19 - from pathogenesis to clinical management: A comprehensive review. World J Gastroenterol 2021; 27:3303-3316. [PMID: 34163113 PMCID: PMC8218363 DOI: 10.3748/wjg.v27.i23.3303] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/10/2021] [Accepted: 05/24/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), is responsible for the first pandemic of the 21st century. As found in adults, signs and symptoms related to the disease mainly involve the respiratory tract in the paediatric population. However, a considerable number of children present with gastrointestinal symptoms such as vomiting, abdominal pain, and diarrhea. The purpose of this review is an accurate description, from pathogenesis to clinical presentation, diagnosis and treatment, of COVID-19 effects on the gastrointestinal system at a paediatric age. SARS-CoV-2 can be identified in stool specimens of affected children by real-time polymerase chain reaction techniques. Positivity can last for several weeks after the end of the symptomatic phase. Gastrointestinal signs and symptoms are generally self-limited, can correlate with blood tests and imaging alterations, and may require supportive treatment such as hydration. However, they can precede severe disease manifestations such as the COVID-19-related multisystem inflammatory syndrome. Children belonging to risk categories such as those affected by celiac disease, inflammatory bowel disease, and hepatic disease seem to not have a more severe course than the others, even if they are undergoing immunosuppressant treatment. Medical follow-ups of patients with chronic diseases need to be revised during the pandemic period in order to postpone unnecessary tests, mainly endoscopic ones.
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Affiliation(s)
- Carmelina Calitri
- Department of Paediatrics, Infermi Hospital, ASLTO3, Rivoli 10098, Italy
| | - Ilaria Fumi
- Department of Paediatrics, Infermi Hospital, ASLTO3, Rivoli 10098, Italy
| | | | - Elena Banino
- Department of Paediatrics, Infermi Hospital, ASLTO3, Rivoli 10098, Italy
| | - Stefania Benetti
- Department of Paediatrics, Infermi Hospital, ASLTO3, Rivoli 10098, Italy
| | | | - Francesca Fantone
- Department of Paediatrics, Infermi Hospital, ASLTO3, Rivoli 10098, Italy
| | - Mariella Pace
- Department of Paediatrics, Infermi Hospital, ASLTO3, Rivoli 10098, Italy
| | - Franco Garofalo
- Department of Paediatrics, Infermi Hospital, ASLTO3, Rivoli 10098, Italy
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30
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Kniepeiss D, Jantscher L, Al-Sharafy S, Sendlhofer G, Schemmer P. Framework for Solid-Organ Transplantation During COVID-19 Pandemic in Europe. Risk Manag Healthc Policy 2021; 14:2421-2433. [PMID: 34113196 PMCID: PMC8187091 DOI: 10.2147/rmhp.s286721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/29/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Since the effect of the COVID-19 pandemic on solid-organ transplantation (SOT) is unclear, an online survey on the specific framework of leading European transplant centers (n=155) in 31 European countries was conducted between April 24 and May 15, 2020. METHODS A questionnaire was designed to collect information on restrictions on SOT, protective measures,(non)governmental information policies, and individual opinions on how to deal with SOT during COVID-19. RESULTS The response rate was 37.4% (58 of 155). Overall, 84.5% reported an effect of COVID-19 on SOT in Europe. In 49% of these, limited capacity was mentioned, and in 51% the reason for restricted resources was strategic preparedness. As a result, SOT was totally or partially suspended for several weeks. In sum, 93.1% of centers implemented protective measures against COVID-19. Nongovernmental information policies were felt to be adequate in 90%. Continuation of transplant activities was desired by 97% of centers. CONCLUSION The results of this survey suggested a need for more ICU capacity during COVID-19, in order to guarantee adequate and timely treatment of other patient cohorts in surveyed countries.
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Affiliation(s)
- Daniela Kniepeiss
- General, Visceral, and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- University Transplant Center Graz (UTCG), Medical University Graz,, Graz, Austria
| | - Lydia Jantscher
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Shahdy Al-Sharafy
- General, Visceral, and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- University Transplant Center Graz (UTCG), Medical University Graz,, Graz, Austria
| | - Gerald Sendlhofer
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Peter Schemmer
- General, Visceral, and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- University Transplant Center Graz (UTCG), Medical University Graz,, Graz, Austria
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Kehar M, Ebel NH, Ng VL, Baquero JER, Leung DH, Slowik V, Ovchinsky N, Shah AA, Arnon R, Miloh T, Gupta N, Mohammad S, Kogan-Liberman D, Squires JE, Sanchez MC, Hildreth A, Book L, Chu C, Alrabadi L, Azzam R, Chepuri B, Elisofon S, Falik R, Gallagher L, Kader H, Mogul D, Mujawar Q, Namjoshi SS, Valentino PL, Vitola B, Waheed N, Zheng MH, Lobritto S, Martinez M. Severe Acute Respiratory Syndrome Coronavirus-2 Infection in Children With Liver Transplant and Native Liver Disease: An International Observational Registry Study. J Pediatr Gastroenterol Nutr 2021; 72:807-814. [PMID: 33605666 PMCID: PMC8183254 DOI: 10.1097/mpg.0000000000003077] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/06/2021] [Indexed: 01/08/2023]
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.
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Affiliation(s)
- Mohit Kehar
- Queen's University, Kingston
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Stanford University, Stanford, CA
| | | | - Vicky L. Ng
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | | | - Amit A. Shah
- Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Nitika Gupta
- Emory University School of Medicine, Atlanta, GA
| | | | | | | | | | | | - Linda Book
- Primary Children's Hospital, Salt Lake City, UT
| | | | | | | | | | | | - Rachel Falik
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Lisa Gallagher
- University of California, San Francisco, San Francisco, CA
| | - Howard Kader
- University of Maryland School of Medicine, Baltimore, MD
| | | | | | | | | | | | - Nadia Waheed
- Children's Hospital and the Institute of Child Health, Lahore, Pakistan
| | - Ming-Hua Zheng
- The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the most recent data describing the impact of coronavirus disease 2019 (COVID-19) on the pediatric population with chronic pulmonary disease. We specifically focus on children with asthma, cystic fibrosis (CF), and lung transplant recipients. RECENT FINDINGS Children with asthma, CF, and lung transplant recipients do not appear to have an increased risk of morbidity or mortality with COVID-19 infection compared to the general pediatric population. Data does not support the change or withdrawal of any asthma or CF maintenance medications; however, does advocate for the cessation of aerosolized medications whenever possible to minimize transmission risk. It may not be necessary to adjust immunosuppressive therapy when managing COVID-19 in pediatric lung transplant patients. Mechanisms of infection in airway epithelial cells in children may differ from adults, resulting in a milder phenotype. SUMMARY Current data about pediatric patients with chronic lung disease infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is promising but remains scarce. Additional study is needed to definitively understand the complex interplay of the SARS-CoV-2 virus in the airway of children with chronic lung disease, how it differs from adults, and how best to manage the symptoms of acute infection.
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Affiliation(s)
- John Palla
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611
| | - Theresa A Laguna
- Division of Pulmonary and Sleep Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611
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33
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Dembiński Ł, Huss G, Radziewicz-Winnicki I, Grossman Z, Mazur A, del Torso S, Barak S, Carrasco Sanz A, Hadjipanayis A. EAP and ECPCP Statement Risks for Children's Health During the COVID-19 Pandemic and a Call for Maintenance of Essential Pediatric Services. Front Pediatr 2021; 9:679803. [PMID: 34046377 PMCID: PMC8146905 DOI: 10.3389/fped.2021.679803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022] Open
Abstract
The COVID-19 pandemic and global lockdown have had drastic socioeconomic and psychological effects on countries and people, respectively. There has been limited access to health care and education. These negative consequences have had a significant impact on the well-being of children and adolescents. Therefore, the EAP and the ECPCP are requesting state, health, and education authorities as well as European pediatric societies and the healthcare professionals that special attention be given to this population and the problems they face as a result of the pandemic.
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Affiliation(s)
- Łukasz Dembiński
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Gottfried Huss
- The European Confederation of Primary Care Paediatricians (ECPCP), Lyon, France
- Kinder-Permanence Spital Zollikerberg, Zollikerberg, Switzerland
| | | | - Zachi Grossman
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Adelson School of Medicine, Ariel University, Ariel, Israel
- Maccabi Health Services, Tel Aviv, Israel
| | - Artur Mazur
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- Medical Faculty, University of Rzeszow, Rzeszów, Poland
| | - Stefano del Torso
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- ChildCare WorldWide, Padova, Italy
| | - Shimon Barak
- The European Confederation of Primary Care Paediatricians (ECPCP), Lyon, France
- Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Angel Carrasco Sanz
- The European Confederation of Primary Care Paediatricians (ECPCP), Lyon, France
- Madrid Health Service, Servicio Madrileño de Salud, Madrid, Spain
| | - Adamos Hadjipanayis
- The European Academy of Paediatrics, EAP, Brussels, Belgium
- School of Medicine, European University Cyprus, Nicosia, Cyprus
- Paediatric Department, Larnaca General Hospital, Larnaca, Cyprus
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Nicastro E, Verdoni L, Bettini LR, Zuin G, Balduzzi A, Montini G, Biondi A, D'Antiga L. COVID-19 in Immunosuppressed Children. Front Pediatr 2021; 9:629240. [PMID: 33996683 PMCID: PMC8116542 DOI: 10.3389/fped.2021.629240] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 03/03/2021] [Indexed: 12/15/2022] Open
Abstract
Following the spread of the SARS-CoV-2 infection and coronavirus disease 2019 (COVID-19) to a global pandemic, concerns have arisen for the disease impact in at-risk populations, especially in immunocompromised hosts. On the other hand, clinical studies have clarified that the COVID-19 clinical burden is mostly due to over-inflammation and immune-mediated multiorgan injury. This has led to downsizing the role of immunosuppression as a determinant of outcome, and early reports confirm the hypothesis that patients undergoing immunosuppressive treatments do not have an increased risk of severe COVID-19 with respect to the general population. Intriguingly, SARS-CoV-2 natural reservoirs, such as bats and mice, have evolved mechanisms of tolerance involving selection of genes optimizing viral clearance through interferon type I and III responses and also dampening inflammasome response and cytokine expression. Children exhibit resistance to COVID-19 severe manifestations, and age-related features in innate and adaptive response possibly explaining this difference are discussed. A competent recognition by the innate immune system and controlled pro-inflammatory signaling seem to be the pillars of an effective response and the premise for pathogen clearance in SARS-CoV-2 infection. Immunosuppression-if not associated with other elements of fragility-do not represent per se an obstacle to this competent/tolerant phenotype in children. Several reports confirm that children receiving immunosuppressive medications have similar clinical involvement and outcomes as the pediatric general population, indicating that maintenance treatments should not be interrupted in suspect or confirmed SARS-CoV-2 infection.
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Affiliation(s)
- Emanuele Nicastro
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Lucio Verdoni
- Pediatric Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Laura Rachele Bettini
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Giovanna Zuin
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Adriana Balduzzi
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Andrea Biondi
- MBBM Foundation, Pediatric Department, Hospital San Gerardo, University of Milano Bicocca, Monza, Italy
| | - Lorenzo D'Antiga
- Pediatric Hepatology, Gastroenterology and Transplantation Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
- Pediatric Unit, Hospital Papa Giovanni XXIII, Bergamo, Italy
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Alshami A, Al Attas R, Azzam A, Mohammed A, Al-Quhaidan N. Detection of SARS-CoV-2 antibodies in pediatric kidney transplant patients. BMC Nephrol 2021; 22:123. [PMID: 33827461 PMCID: PMC8025893 DOI: 10.1186/s12882-021-02325-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/25/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The seroprevalence of SARS-CoV-2 infection has been studied in immunocompetent children. However, data in the pediatric kidney transplant population (PKT) are lacking. METHODS Using two commercial immunoassays that measured IgG antibodies against SARS-CoV-2 spike protein and IgG against the nucleocapsid (N) protein, we screened 72 PKT recipients who attended the outpatient clinic for routine blood work. The majority of patients with positive serology underwent an additional serology test at least once during subsequent clinical follow-up. Patients were confirmed to have SARS-CoV-2 infection if they had two positive tests. RESULTS Eight patients out of the 72 screened (11.1%) had positive results for SARS-CoV-2 IgG antibodies in both serological tests. Of those who tested positive, 4 had positive SARS-CoV-2 PCR results before screening. All patients were asymptomatic or had a history of mild symptoms. All tested patients had persistently positive antibodies at a median follow-up time of 75 days (IQR, 44.5, 86.5 days). One patient had a positive PCR test at 75 days and a positive serology test at 120 days post infection. CONCLUSION The seroprevalence of SARS-CoV-2 was relatively high (11.1%) in our population. Although all patients were asymptomatic or mildly symptomatic, they mounted a strong humoral immune response that persisted for a few months despite being on triple immunosuppressants. These findings have positive implications regarding vaccination efficacy in this group.
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Affiliation(s)
- Alanoud Alshami
- Division of Pediatric Nephrology and Kidney Transplant, Multiorgan Transplant Center, King Fahad Specialist Hospital-Dammam/Saudi Arabia, Dammam, Saudi Arabia.
| | - Rabab Al Attas
- Division of Immunology, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia, Dammam, Saudi Arabia
| | - Ahmad Azzam
- Division of Pediatric Nephrology and Kidney Transplant, Multiorgan Transplant Center, King Fahad Specialist Hospital-Dammam/Saudi Arabia, Dammam, Saudi Arabia
| | - Amani Mohammed
- Division of Immunology, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia, Dammam, Saudi Arabia
| | - Norah Al-Quhaidan
- Division of Immunology, Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital, Dammam, Saudi Arabia, Dammam, Saudi Arabia
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Di Giorgio A, Hartleif S, Warner S, Kelly D. COVID-19 in Children With Liver Disease. Front Pediatr 2021; 9:616381. [PMID: 33777864 PMCID: PMC7991080 DOI: 10.3389/fped.2021.616381] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background: The global pandemic caused by novel Coronavirus SARS-CoV-2 disease (COVID-19) is a major threat to the general population and for patients with pre-existing chronic conditions. We report data concerning SARS-CoV-2 infection in children with chronic liver disease (CLD). Methods: A literature review using the online database PubMed was performed to summarize available findings on the association between pre-existing liver disease and COVID-19 infection in children. Results: Children with COVID-19 have preserved effector and immunosuppressive components resulting in a milder disease compared to adults. The most common hepatic manifestation is an elevation of hepatic transaminases. Liver damage may be directly caused by viral infection of liver cells, by medications or by the chronic hypoxia seen in COVID-19 patients. A multicenter study reported that the majority of children with a CLD remained healthy during the outbreak. Similarly, studies reported that children on immunosuppressive treatment, including patients with autoimmune liver disease (AILD) and liver transplantation (LT), maintained good health during the outbreak without experiencing major complications even if infected with COVID-19. Conclusion: COVID-19-related liver injury presents with a mild elevation of transaminases, although its clinical significance is unclear. Children with CLD, including those with AILD and post-LT, do not have an increased risk for severe disease course of SARS-CoV-2 infection with little or no liver dysfunction. These data highlight the necessity to ensure normal standards of care while adhering to national Covid-19 guidelines, and particularly to maintain immunosuppressive medication to prevent relapse or rejection. Further research is required to evaluate the differences in clinical course between immunosuppressed adults and children and in particular whether asymptomatic infection is a concern.
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Affiliation(s)
- Angelo Di Giorgio
- Paediatric Liver, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Steffen Hartleif
- Paediatric Gastroenterology and Hepatology, University Children's Hospital, University of Tübingen, Tübingen, Germany
| | - Suzan Warner
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
- The Liver Unit, Birmingham Women's and Children's Hospital, University of Birmingham, Birmingham, United Kingdom
| | - Deirdre Kelly
- The Liver Unit, Birmingham Women's and Children's Hospital, University of Birmingham, Birmingham, United Kingdom
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37
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Bensoussan E, Ouldali N, Ashkenazi S, Angoulvant F, Cohen R, Levy C. Impact of Coronavirus Disease 2019 (COVID-19) Pandemic on Pediatric Infectious Disease Research. J Pediatr 2021; 230:279-281.e2. [PMID: 33271191 PMCID: PMC7834229 DOI: 10.1016/j.jpeds.2020.11.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Indexed: 12/30/2022]
Affiliation(s)
- Eden Bensoussan
- Faculty of Life Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Naim Ouldali
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France,Unité d’épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, ECEVE INSERM UMR 1123, Paris, France,GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France
| | - Shai Ashkenazi
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - François Angoulvant
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,INSERM, Centre de Recherche des Cordeliers, UMRS 1138, Sorbonne Université, Université de Paris, Paris, France,Assistance Publique - Hôpitaux de Paris, Pediatric Emergency Department, Necker-Enfants Malades University Hospital, Université de Paris, Paris, France
| | - Robert Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France,GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France,Université Paris Est, IMRB-GRC GEMINI, Créteil, France,Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France,AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - Corinne Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Créteil, France; GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France; Université Paris Est, IMRB-GRC GEMINI, Créteil, France; Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, France; AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France.
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Maurer K, Saucier A, Kim HT, Acharya U, Mo CC, Porter J, Albert C, Cutler C, Antin JH, Koreth J, Gooptu M, Romee R, Wu CJ, Soiffer RJ, Nikiforow S, Jacobson C, Ho VT. COVID-19 and hematopoietic stem cell transplantation and immune effector cell therapy: a US cancer center experience. Blood Adv 2021; 5:861-871. [PMID: 33560397 PMCID: PMC7869610 DOI: 10.1182/bloodadvances.2020003883] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/06/2021] [Indexed: 02/07/2023] Open
Abstract
The novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), identified in late 2019 as the causative agent of COVID-19, was declared a pandemic by the World Health Organization on 11 March 2020. Widespread community transmission in the United States triggered a nationwide shutdown, raising major challenges for administration of hematopoietic stem cell transplant (HSCT) and chimeric antigen receptor (CAR)-T cell therapies, leading many centers to delay or cancel operations. We sought to assess the impact of the COVID-19 pandemic on operations and clinical outcomes for HSCT and CAR-T cellular therapies at the Dana-Farber Cancer Institute by reviewing administration and outcomes in 127 cell therapy patients treated during the initial COVID-19 surge: 62 adult allogeneic HSCT (allo-HSCT), 38 autologous HSCT (auto-HSCT), and 27 CAR-T patients. Outcomes were compared with 66 allo-HSCT, 43 auto-HSCT, and 33 CAR-T patients treated prior to the pandemic. A second control cohort was evaluated for HSCT groups to reflect seasonal variation in infections. Although there were changes in donor selection and screening as well as cryopreservation patterns of donor products, no differences were observed across groups in 100-day overall survival, progression-free survival, rates of non-COVID-19 infections, including hospital length of stay, neutrophil engraftment, graft failure, acute graft-versus-host disease in allo-HSCT patients, or cytokine release syndrome and neurotoxicity in CAR-T patients. No HSCT patients contracted COVID-19 between days 0 and 100. One CAR-T patient contracted COVID-19 at day +51 and died of the disease. Altogether, our data indicate that cellular therapies can be safely administered throughout the ongoing COVID-19 pandemic with appropriate safeguards.
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Affiliation(s)
- Katie Maurer
- Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Anna Saucier
- Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Haesook T Kim
- Department of Data Science, Dana-Farber Cancer Institute, Harvard School of Public Health, Boston, MA; and
| | - Utkarsh Acharya
- Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Clifton C Mo
- Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Julie Porter
- Department of Cellular Therapies Quality Assurance and
| | - Cindy Albert
- Stem Cell Transplant Donor Services, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Corey Cutler
- Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Joseph H Antin
- Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - John Koreth
- Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Mahasweta Gooptu
- Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Rizwan Romee
- Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Catherine J Wu
- Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Robert J Soiffer
- Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Sarah Nikiforow
- Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Caron Jacobson
- Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Vincent T Ho
- Division of Hematologic Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
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39
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Sahu KK, Siddiqui AD. A review on recipients of hematopoietic stem cell transplantation patients with COVID-19 infection. Ther Adv Infect Dis 2021; 8:20499361211013252. [PMID: 33996075 PMCID: PMC8111517 DOI: 10.1177/20499361211013252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/08/2021] [Indexed: 02/06/2023] Open
Abstract
For the last few months, various geographical regions and health sectors have been facing challenges posed by the current COVID-19 pandemic. COVID-19 has led to significant disruption in the normal functioning of potentially life-saving therapies of hematopoietic cell transplant and chimeric antigen receptor therapy. As transplant physicians are gaining more information and experience regarding the undertaking of these complex procedures during the ongoing COVID-19 pandemic, we believe it is important to discuss the challenges faced, prognostic risk factors, and outcomes of COVID-19 in post-hematopoietic stem cell transplantation patients based on the available real-world data.
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Affiliation(s)
- Kamal Kant Sahu
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, USA
| | - Ahmad Daniyal Siddiqui
- Hemato-Oncology Division, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
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