Pediatric Transplantation

Impact of COVID-19 Pandemic on Pediatrics and Pediatric Transplantation Programs

    COVID-19 has dramatically altered the healthcare landscape and has disrupted global health and world economics. The impact of COVID-19 on children with chronic conditions or those undergoing transplantation continue to evolve to this day. In this metanalysis, Columbia University research led by Steven Lobritto, MD, Medical Director of Pediatric Liver Transplantation reviewed the organ-specific manifestations of COVID-19 in children and outlined treatment strategies from data collected during the initial 6 months of the pandemic.

    • The impact of COVID-19 on pediatric transplantation in the United States over the initial 6 months of the pandemic showed significant regional variation. Lags persist in the resumption of normal transplant activity, particularly for living donor related transplantation.
    • One organ specific manifestation of COVID-19 is Multisystem Inflammatory Syndrome in Children (MIS-C), a delayed illness unique to children and young adults with COVID-19, characterized by inflammation involving at least two or more organ systems, including cardiac, renal, respiratory, gastrointestinal, neurological, dermatologic and/or hematologic. Children may require transplantation if organ dysfunction fails to recover.
    • Over the initial 6 months of the pandemic, pediatric transplantation was down approximately 10% in 2020. Compared to 1,375 pediatric transplants performed by early September 2019, as of 9/10/2020 there were only 1,202 pediatric transplants.
    • The major decrease was seen with living donor transplantation compared to deceased donor transplantation, which may reflect a stepwise reduction in activity, beginning with “elective” living donor transplants, during the early phases of the pandemic.
    • In some regions such as the Mid-Atlantic, living donation mitigated the decrease of available deceased donors in the same region. The regional differences were also impacted by the nearly simultaneous advent of acuity circle distribution in the US, a system based on the distance between donor hospital and transplant hospital.
    • As of study publication, pediatric transplant activity began to approach pre-pandemic levels.
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      Lobritto S, Danziger-Isakov L, Michaels MG, Mazariegos GV. Front Pediatr. 2020 Dec 10;8:612627. doi: 10.3389/fped.2020.612627. eCollection 2020.PMID: 33363069

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