Dear IPTA members,
We would like to announce an exciting new IPTA initiative of developing new guidelines across various organ systems as well as developing these in collaboration with other organizations, for publication in Pediatric Transplantation.

This is a call for:

1. Volunteers – you may be early in your career and wish to learn how to develop guidelines, which can then be added to your CV; or you may be more advanced in your career but wishing to mentor more junior career colleagues.
2. Your ideas! - Guideline topics ideas as well as suggestions of collaboration between different organizations would also be appreciated.

We ask you to send us your names and ideas by 10 January 2022. Please send to Katie Tait, IPTA Section Manager, at katie.tait@tts.org

Yours sincerely,

Mignon McCulloch
Past President, IPTA

This update is presented by Irene Kim, Chair of IPTA Membership Committee

IPTA is over 500 members strong and the Membership Committee would like to thank current members for your continued engagement. We look forward to welcoming members to the 11^th Congress of the International Pediatric Transplant Association in Prague, Czech Republic, where members will enjoy a reduced registration fee. In addition, IPTA members enjoy a number of benefits, including:

COVID-19 toolkit summarizing published SOT data with resource links for both IPTA members and SOT families:

• Access to IPTA website, including Member’s Only section
• Subscription to Pediatric Transplantation
• Access to pediatric-related videos from TTS 2020
• Access to the IPTA quarterly newsletter
• Access to education from IPTA meetings including pediatric symposia from ATC and post-graduate course presentations

If you have already paid your 2022 dues, thank you for your support of IPTA! If you have not yet paid, please click here to renew your membership now. Your ongoing support is greatly appreciated!

Sincerely,

Irene Kim
Chair, Membership Committee

We continue to spotlight our incredible Allied Health and Nursing Professionals Committee, this time focusing on Caroline Piotrowoski, Child Heath Researcher. Click below to read more about Caroline and her important work.

If you haven’t registered for our in-person Congress in Prague in March 2022, please don’t forget to do so! Early Bird Registration ends on January 6th, 2022 so go ahead, give yourself a holiday treat and help children requiring transplant at the same time! For more information on our Meeting, including full Program and Registration, please click the link below.

www.ipta2022.org

In our last IDCARE committee contribution to the IPTA newsletter, we provided a brief update on COVID-19 in pediatric solid organ transplantation (SOT) recipients. That was approximately 5 months into the pandemic – a time seemingly short and yet so long ago. We have learned much about the impact of SARS-CoV-2 in children and in SOT recipients in the interim, though knowledge gaps remain.1,2 It is only fitting that 1 year later, we now provide an update on SARS-CoV-2 and COVID-19 vaccines in children and in SOT recipients.

We now know that children can transmit and become infected with SARS-CoV-2.^3-6 Indeed, the number of pediatric COVID-19 cases has increased since the start of the pandemic and as of early May 2021, children contribute to approximately 24% of all new COVID-19 cases in the US. The numbers for Europe and Latin America are currently unknown. Yet, these numbers are likely an under-representation of true COVID-19 burden in children, as it is estimated that > 22 million children in the US were likely infected.⁹ In general, COVID-19 causes milder disease and leads to fewer hospitalizations in children compared with adults.^3,10-13 However, severe disease can occur and COVID-19 related pediatric deaths have now surpassed the highest recorded number of influenza-related deaths during the 2019-20 season in the US.^8,14,15 Younger age and underlying comorbid conditions, including obesity, diabetes, and immunocompromise, have been identified as predictors of severe COVID-19 disease in children in some studies.^16-20

When assessing COVID-19 data among SOT recipients, adult recipients are at risk for severe SARS-CoV-2 infection and in some studies have worse outcomes when compared with immunocompetent adults, with reported mortality rates of 13 to >30%.^21-25 In addition, adult SOT recipients have been shown to have more rapidly waning immunity after natural infection compared with immunocompetent adults.²⁶ Published data regarding acute COVID-19 among pediatric SOT recipients report a generally mild clinical course with outcomes similar to immunocompetent children.^27,28 Similarly, the true burden of SARS-CoV-2 in pediatric SOT recipients is likely under-represented, including how the pandemic has affected pediatric transplantation.^29-31 In addition, the emergence of multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome (PIMS), suspected to be a post-infectious severe hyperinflammatory response to SARS-CoV-2 infection has been reported in a pediatric liver transplant recipient despite ongoing immunosuppression, that adversely affected the allograft.³²

Global COVID-19 vaccination will be crucial in curbing the pandemic. Unfortunately, children and adult and pediatric SOT recipients were excluded from the initial COVID-19 vaccine trials. As medical advocates for our patients, we support and encourage their participation in COVID-19 vaccine clinical trials. Data are now emerging regarding the safety, immunogenicity, and efficacy of COVID-19 vaccines in adult SOT recipients. Extrapolating from experiences with other vaccines, it is expected that immunocompromised SOT recipients will have a blunted antibody response to COVID-19 vaccines. Indeed, preliminary data in adult SOT recipients report a lower percentage of patients mounting a positive antibody response after COVID-19 mRNA vaccines.^33-35 In the largest series that included 658 SOT recipients, 54% of subjects had antibody detection a median of 29 days (28-31) after the second dose of COVID-19 mRNA vaccine and importantly, no alloreactivity was reported. These initial data were not poised to evaluate vaccine-induced cellular immunity or vaccine efficacy. Although the precise antibody correlate of SARS-CoV-2 protection remains to be established, durable vaccine-induced antibody concentrations have been reported to last 6 months after the second COVID-19 mRNA vaccine dose in immunocompetent individuals ≥ 18 years of age.³⁶ Additional data are needed to evaluate the longevity of vaccine-induced antibody concentrations in the SOT population²⁶ and future studies are expected to evaluate the need for possible booster vaccine doses.³⁷ Additional data are also needed regarding efficacy of current COVID-19 vaccines against SARS-CoV-2 variants.^38-40 Understanding these knowledge gaps may also help foster confidence in COVID-19 vaccination and reduce vaccine hesitancy.

Children represent ≥ 20% of the population in most countries, as such their inclusion in vaccine efforts may help contribute to achieving herd immunity. Data reported from COVID-19 mRNA vaccine clinical trials that enrolled immunocompetent children 12-15 years of age suggest that these vaccines are safe and effective in preventing COVID-19.

Case #1
A 5 year old child was diagnosed with focal segmental glomerulosclerosis. Her kidney function declined and she now requires hemodialysis. She had been doing well; however she was being considered for kidney transplantation. Her medical team recommended routine vaccination as a requirement for candidacy. Her family had agreed to only vaccinate against certain pathogens, but has refused vaccination against a newer virus in the community that is highly transmissible and for which there is an ongoing local epidemic. This virus has a high rate of causing partial paralysis in children from natural infection, has a 1% mortality rate, and is highly transmissible. The family refused vaccination because they are concern about safety and that it is a new vaccine. They stated that they will keep their child safe with masks and quarantining. However, the transplant team was unwilling to proceed with transplant and contacted child protective services to compel the vaccination.

Case #2
A 5 year old child was diagnosed with focal segmental glomerulosclerosis. Her kidney function declined and she now requires hemodialysis. She had been doing well; however she was being considered for kidney transplantation. Her medical team recommended routine vaccination as a requirement for candidacy. Her family had agreed to only vaccinate against certain pathogens, but has refused vaccination against a newer virus in the community that is highly transmissible and for which there is an ongoing local epidemic. This virus has a high rate of causing partial paralysis in children from natural infection, has a 1% mortality rate, and is highly transmissible. The family refused vaccination because they are concern about safety and that it is a new vaccine. They stated that they will keep their child safe with masks and quarantining. However, the transplant team was unwilling to proceed with transplant and contacted child protective services to compel the vaccination.