COVID-19 in transplant recipient children: An Iranian referral hospital-based study

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Golnaz Ghazizadeh Esslami
Setareh Mamishi
Shima Mahmoudi
Amene Navaeian
Maryam Behfar
Amir Ali Hamidieh
Hosein Alimadadi
Yasmine Mahmoudieh


COVID-19, SARS-CoV-2, immunocompromised, transplant, children


To our knowledge, there is still very limited information on the severity, mortality, laboratory, and radiologic findings of COVID‐19 infection in transplant patients, particularly children. In this study, we report and analyze 7 transplant recipients with laboratory‐confirmed COVID‐19 infection. The median age was 7.5 years (IQR: 31month-10 years), and 71% of the patients were male. All cases presented with a fever. The median duration of fever before admission was 2 days (IQR:1-8 days). Five patients (71%) experienced cough and dyspnea. Lymphocytopenia (Median of 0.6 (IQR: 0.14-2.0× 10⁹ cells per L) and thrombocytopenia (Median of 65 (IQR: 49-201× 10⁹ cells per L) were the most common CBC findings (both seen in 5 out of the 7 patients. Among 4 of the patients who underwent CT scans, 2 had ground glass opacity and consolidations. The mean number of lobe involvement in our patients was 3(0-5), and 75% of the cases showed bilateral lung involvement in the imaging. In 4 patients (51%) the disease course manifested severely, and 2 patients are now deceased (28.6%). In conclusion, immunocompromised pediatric subgroups may experience higher rates of disease severity and mortality in comparison with the immunocompetent pediatric population.


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1. Organization WH. Coronavirus disease 2019 (COVID-19): situation report, 70. 2020.
2. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood. 2020;135(23):2033-40.
3. Liu J, Zheng X, Tong Q, et al. Overlapping and discrete aspects of the pathology and pathogenesis of the emerging human pathogenic coronaviruses SARS‐CoV, MERS‐CoV, and 2019‐nCoV. J Med Virol. 2020;92(5):491-4.
4. Mahmoudi S, Rezaei M, Mansouri N, Marjani M, Mansouri D. Immunologic features in coronavirus disease 2019: functional exhaustion of T cells and cytokine storm. J Clin Immunol. 2020;40(7):974-6.
5. Rahimzadeh G, Ekrami Noghabi M, et al. COVID-19 infection in Iranian children: a case series of 9 patients. J Pediatr Review. 2020;8(2):139-44.
6. Fang Y, Zhang H, Xie J, et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology. 2020:200432.
7. Memar EHE, Mamishi S, Ekbatani MS, et al. Fulminant hepatic failure: a rare and devastating manifestation of Coronavirus disease 2019 in an 11-year-old boy. Archives de Pédiatrie. 2020.
8. Ekbatani M, Hassani S, Tahernia L, et al. Atypical and novel presentations of coronavirus disease 2019: a case series of three children. Br J Biomed Sci. 2020:1-6.
9. Dong Y, Mo X, Hu Y, et al. Epidemiological characteristics of 2143 pediatric patients with 2019 coronavirus disease in China. Pediatrics. 2020.
10. Mahmoudi S, Mehdizadeh M, Badv RS, et al. The coronavirus disease 2019 (COVID-19) in children: a study in an Iranian Children’s Referral Hospital. Infect Drug Resist. 2020;13:2649.
11. Mamishi S, Movahedi Z, Mohammadi M, et al. Multisystem inflammatory syndrome associated with SARS-CoV-2 infection in 45 children: a first report from Iran. Epidemiol Infect
. 2020;148.
12. Chan JF-W, Yuan S, Kok K-H, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;395(10223):514-23.
13. Zhang Y, Lin D, Xiao M, et al. 2019-novel coronavirus infection in a three-month-old baby. Zhonghua Er Ke Za Zhi. 2020;58:E006.
14. Cui X, Zhang T, Zheng J, et al. Children with Coronavirus Disease 2019 (COVID‐19): A Review of Demographic, Clinical, Laboratory and Imaging Features in 2,597 Pediatric Patients. J Med Virol. 2020;92(9):1501-1510.
15. Wei M, Yuan J, Liu Y, Fu T, Yu X, Zhang Z-J. Novel coronavirus infection in hospitalized infants under 1 year of age in China. JAMA. 2020;323(13):1313-4.
16. Sun D, Li H, Lu X-X, et al. Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center’s observational study. World J Pediatr. 2020;16(3):251-259.
17. Cai J, Xu J, Lin D, et al. A Case Series of children with 2019 novel coronavirus infection: clinical and epidemiological features. Clin Infect Dis. 2020. PMID: 32112072.
18. Inciardi RM, Adamo M, Lupi L, et al. Characteristics and outcomes of patients hospitalized for COVID-19 and cardiac disease in Northern Italy. Eur Heart J. 2020;41(19):1821-9.
19. Fung M, Babik JM. COVID-19 in immunocompromised hosts: what we know so far. Clin Infect Dis. 2020:ciaa863.
20. Zamperlini-Netto G, Fernandes JF, Garcia JL, et al. COVID-19 after hematopoietic stem cell transplantation: report of two children. Bone Marrow Transplant. 2020 Sep 16.
21. Hrusak O, Kalina T, Wolf J, et al. Flash survey on SARS-CoV-2 infections in pediatric patients on anti-cancer treatment. Eur J Cancer. 2020;132:11-16.
22. Fontana L, Strasfeld L. Respiratory virus infections of the stem cell transplant recipient and the hematologic malignancy patient. Infect Dis Clin North Am. 2019 Jun;33(2):523-544.
23. Yang AP, Li HM, Tao WQ, et al. Infection with SARS-CoV-2 causes abnormal laboratory results of multiple organs in patients. Aging. 2020;12.
24. Soltani J, Sedighi I, Shalchi Z, Sami G, Moradveisi B, Nahidi S. Pediatric coronavirus disease 2019 (COVID-19): An insight from west of Iran. North Clin Istanb
. 2020 May 4;7(3):284-291
25. Ding Y, Yan H, Guo W. Clinical characteristics of children with COVID-19: a meta-analysis. Front Pediatr. 2020;8:431.
26. Mamishi S, Heydari H, Aziz-Ahari A, et al. Novel coronavirus disease 2019 (COVID-19) outbreak in children in Iran: atypical CT manifestations and mortality risk of severe COVID-19 infection. J Microbiol Immunol Infect. 2020;S1684-1182(20)30177-8.
27. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet
. 2020 Mar 28;395(10229):1054-1062.
28. Katal S, Johnston S, Johnston J, Gholamrezanezhad A. Imaging findings of SARS-CoV-2 infection in pediatrics: A systematic review of coronavirus disease 2019 (COVID-19) in 850 patients. Acad Radiol. 2020 Nov;27(11):1608-1621