SARS-CoV-2 BA.2 (Omicron) variant infection in pediatric liver transplanted recipients and cohabitants during 2022 Shanghai outbreak: a prospective cohort

Abstract

Background: The Omicron variant BA.2 was the dominant variant in the COVID-19 outbreak in Shanghai since March 2022. We aim to investigate the characteristics of SARS-CoV-2 Omicron variant infection in pediatric liver-transplanted recipients.

Methods: We conducted a single-center, prospective, observational, single-arm study. We enrolled pediatric liver-transplanted patients infected with the Omicron variant BA.2 from March 19th to October 1st, 2022 and analyzed their demographic, clinical, laboratory, and outcome data. The management of COVID-19 was conducted according to the 9th trial edition of the Chinese guideline. The immunosuppressive therapy was tailored considering the patients' infection developments and liver functions.

Results: Five children were included. The primary diseases included Niemann-Pick disease, propionic acidemia, decompensated cirrhosis, biliary atresia, and Crigler-Najjar syndrome type I. All of the patients were onset with fever before or when getting RNA-positive results at the age of 3 (Range: 1-13) years. The infection duration was 29 (Range: 18-40) days. Three and two children were diagnosed with mild and moderate COVID-19 respectively. Two patients were tested RNA-positive within 14 days after having been tested negative. The immunosuppressants were paused or extenuated in four patients. Eight of all nine cohabitants were injected with at least two doses of inactivated SARS-CoV-2 vaccine. The disease courses were significantly longer than the patients (P < 0.05).

Conclusions: Post-transplant immunosuppression slows down the virus clearance and increases the risk of relapse but does not affect symptom duration or infection severity in pediatric patients. Patients can usually gain a favorable outcome and prognosis by extenuating immunosuppressants.

Keywords: Children; Immunosuppression; Liver transplantation; SARS‐CoV‐2; Solid organ.

Fig. 1

The chest radiography of Patient A. (a) post-LT: typical imaging presentation of Niemann-Pick Disease; (b) in the early stage (the 2nd day) of SARS-CoV-2 infection: no visible change; (c) in the later stage (the 21st day) of SARS-CoV-2 infection: increased and blurred texture in both lungs with patchy exudate

Fig. 2

The disease course of the two relapse patients. (a) Patient A; (b) Patient C. lym(#) lymphocyte count, ALT alanine transaminase, CRP C‐reactive protein, TAC tacrolimus, PA prednisone acetate, CsA cyclosporin A, MMF mycophenolate mofetil, q12h every 12 h, qd every day