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World J Transplant. May 18, 2022; 12(5): 88-99
Published online May 18, 2022. doi: 10.5500/wjt.v12.i5.88
Pediatric transplantation during the COVID-19 pandemic
Christos Dimitrios Kakos, Ioannis A Ziogas, Georgios Tsoulfas
Christos Dimitrios Kakos, Ioannis A Ziogas, Surgery Working Group, Society of Junior Doctors, Athens 15123, Greece
Ioannis A Ziogas, 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
Author contributions: Kakos CD, Ziogas IA, and Tsoulfas G designed the research study; Kakos CD and Ziogas IA performed the research, analyzed the data, and wrote the manuscript; Tsoulfas G critically revised the manuscript; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Georgios Tsoulfas, FACS, FICS, MD, PhD, Professor, Department of Transplantation Surgery, Aristotle University School of Medicine, 66 Tsimiski Street, Thessaloniki 54622, Greece.
Received: December 13, 2021
Peer-review started: December 13, 2021
First decision: March 13, 2022
Revised: March 16, 2022
Accepted: April 20, 2022
Article in press: April 20, 2022
Published online: May 18, 2022

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.

Keywords: Pediatric, Transplantation, SARS-CoV-2, COVID-19, Immunosuppression

Core Tip: Pediatric patients experience milder symptoms of coronavirus disease 2019 (COVID-19). Pediatric solid organ transplantation during the COVID-19 pandemic represents a real challenge not only for the solid organ transplantation candidates and recipients but also for the transplant clinicians. Immunosuppression increases the risk of COVID-19 but may also provide a benefit against possible infection, as it lowers the risk of a catastrophic hyperinflammatory response from the host. We herein review the currently available evidence regarding pediatric solid organ transplantation during the COVID-19 pandemic.