COVID-19 vaccination in pediatric solid organ transplant recipients—Current state and future directions

Population-level COVID-19 immunization will play a key role in slowing down the SARS-CoV-2 pandemic on a global scale and protect the most at-risk individuals. Thanks to a formidable universal effort, several SARS-CoV-2 vaccines have been marketed less than a year since the first documented COVID-19 case, with promising safety, efficacy, and immunogenicity results in adults. As children were not included in the initial trials, no vaccine is currently approved for individuals <16 years of age. Similarly, immunosuppressed individuals, such as solid organ transplant recipients, were excluded from initial vaccine trials, limiting the understanding of vaccine immunogenicity and safety in this at-risk population. Thus, data regarding COVID-19 vaccination in pediatric solid organ transplantation recipients are currently lacking.

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Evaluation and approach to the presence of active infection in the potential pediatric transplant recipient.

Pneumocystis prophylaxis strategies across centers
This was a survey based assessment of current strategies used for prevention of PJP by various centers.We are now developing the manuscript for submission to Pediatric Transplantation with a goal of submission by the end of November

Yearly Influenza update
The ID CARE committee recruited prior authors of our first Influenza Update previously published in Pediatric Transplantation ~ 1-2 years ago to provide an update for the recently ended season as well as for the upcoming season(s) this summer and winter.

CMV Guidelines and Pediatric Case-Based Commentary for Pediatric Transplantation
Members of the ID CARE Committee participated in the TTS 3rd CMV Consensus Conference.

This Guideline has now been formally published. In addition, this same group of Pediatric clinicians created a case-based manuscript to highlight key points and changes in recommendations in the 3rd edition of the CMV guidelines. This paper has been accepted by Pediatric Transplantation and is available on-line.

EBV/PTLD Consensus Conference
This is an IPTA sponsored consensus conference addressing the diagnosis, management and prevention of EBV associated PTLD in pediatric SOT recipients. The conference is being co-sponsored by Vanderbilt University and Their Children’s Hospital, Children’s Hospital of Pittsburgh and Sick Kid’s Hospital in Toronto. The effort is being organized under the ID CARE committee with Steve Webber, Upton Allen and Michael Green as co-chairs of the conference. The conference planned for March 11-12, 2019.

Emerging mosquito borne viruses and impact on transplantation
The IPTA Council had requested the ID CARE committee to develop a manuscript addressing to topic of emerging mosquito borne viral infections (e.g. ZIKA, Dengue and Chikungunya) and their relevance to pediatric transplantation.

Authors from the University of Pittsburgh’s Division of Infectious Diseases with interest and expertise with these viruses were recruited and developed this manuscript. The manuscript has been accepted by Pediatric Transplantation and I believe it is available online.

VZV and other live vaccine post-transplant

This topic covers two related efforts by the ID CARE Committee. The first of these relates to the Consensus meeting organized by Upton Allen and Sick Kids in Toronto focused on use of MMR and varicella in pediatric transplant recipients. Unfortunately, the process of completing this manuscript has been slower than we anticipated but we do expect to have it available for review by all participants in the next month or so. This was more a project of Dr. Allen’s and Sick Kids than truly an effort by the Committee.

The second effort related to this is a survey looking to document current state of use of live viral vaccines in pediatric organ recipients at this time. This effort has been somewhat delayed due to work conflicts affecting the key individuals responsible for this effort. We hope to send this survey out sometime in October 2018.

Approach to Diarrhea
The ID CARE Committee is developing an algorithm for the approach to diagnosis and management of diarrhea in the pediatric organ transplant recipients. This effort is being led by a multidisciplinary team of pediatric transplant clinicians with a goal of providing an evidence based set of recommendations.

Antibiotic prophylaxis survey
The ID CARE Committee is now proposing to develop a case-based practical survey to highlight what the current state of care is in terms of antibiotic perioperative prophylaxis for pediatric liver transplant recipients.

The working group for this initiative have begun drafting the cases for this survey. We would anticipate completion by the end of November 2018 with a hope to send the survey out sometime after that.

SARS-CoV-2 and pediatric solid organ transplantation: Current knowns and unknowns

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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