tetano
Editor, Senior Moderator
Transpl Infect Dis
. 2026 Aug 13:e70303.
doi: 10.1111/tid.70303. Online ahead of print.
Risk Factors for Coronavirus Disease 2019 Hospitalization and Vaccination Impact Among Pediatric Solid Organ Transplant Recipients in the United States
Sanya J Thomas[SUP] 1 2 3 4 [/SUP], Natalia E Castillo Almeida[SUP] 5 [/SUP], Claire Bocchini[SUP] 6 [/SUP], Caitlin Brammer[SUP] 7 8 [/SUP], Guy Brock[SUP] 9 [/SUP], Abigail Calimaran[SUP] 10 [/SUP], Ronald Dallas[SUP] 11 [/SUP], Kevin J Downes[SUP] 10 12 [/SUP], Jose A Ferrolino[SUP] 11 [/SUP], Md Rejuan Haque[SUP] 9 [/SUP], Anna R Huppler[SUP] 13 [/SUP], Ishminder Kaur[SUP] 14 [/SUP], Madan Kumar[SUP] 15 [/SUP], Meghan Landry[SUP] 16 [/SUP], Stacee Lerret[SUP] 13 [/SUP], Gabriela M Maron[SUP] 11 [/SUP], Timothy D Minniear[SUP] 17 18 [/SUP], William J Muller[SUP] 19 20 [/SUP], Flor M Munoz[SUP] 21 [/SUP], William R Otto[SUP] 7 8 [/SUP], Kerrigan Perkins[SUP] 7 8 [/SUP], Elizabeth H Ristagno[SUP] 22 [/SUP], Anna Sharova[SUP] 10 12 [/SUP], Katherine Siegel[SUP] 13 [/SUP], Eunkyung Song[SUP] 1 2 [/SUP], Marion Jose Valladares[SUP] 23 [/SUP], Natasha A Wilson[SUP] 5 [/SUP], Allison Yoshida[SUP] 5 24 [/SUP], Masako Shimamura[SUP] 1 2 25 [/SUP]
Affiliations
Background: While vaccination is a key strategy to mitigate the severity of coronavirus disease 2019 (COVID-19) in children, the risk factors for symptomatic, medically attended (hereon referred to as "symptomatic") COVID-19 and the impact of vaccination are not well defined among pediatric solid organ transplant recipients (PSOTR).
Methods: PSOTR aged six months through 21 years at 11 centers in the Pediatric Infectious Diseases Transplant Network (PIDTRAN) were analyzed retrospectively for symptomatic COVID-19 between July 2021 and May 2023. Using a Cox proportional hazards model, risk factors associated with COVID-19-associated hospitalization, in-hospital oxygen use, mechanical ventilation, and the impact of COVID-19 vaccination were analyzed.
Results: Of 1370 PSOTR, 410 (29%) had symptomatic COVID-19 infection. Among those with symptomatic infection, 115 (28%) were hospitalized, 35 required in-hospital oxygen, and three required mechanical ventilation. In the study, 45% were unvaccinated against COVID-19. Compared to unvaccinated PSOTR, incompletely vaccinated PSOTR had 56% lower hazard (95% CI 0.26, 0.72, p = 0.001) of COVID-19-associated hospitalization whereas completely vaccinated did not have a statistically significant difference in hazard of hospitalization. Receipt of at least one dose of the bivalent vaccine was also associated with 92.5% lower hazard (95% CI 0.010, 0.55, p = 0.011) of hospitalization. Risk factors for hospitalization included chronic kidney disease, underlying heart disease, neurodevelopmental delay, and lymphocytopenia.
Conclusions: Most PSOTR with symptomatic COVID-19 did not require hospitalization or respiratory support. Several comorbidities and lymphocytopenia are associated with severe COVID-19 in PSOTR. COVID-19 vaccination, mostly, protected PSOTR against COVID-19-associated hospitalization, but vaccine uptake among PSOTR was low.
Keywords: COVID‐19; pediatrics; transplant; vaccines.
. 2026 Aug 13:e70303.
doi: 10.1111/tid.70303. Online ahead of print.
Risk Factors for Coronavirus Disease 2019 Hospitalization and Vaccination Impact Among Pediatric Solid Organ Transplant Recipients in the United States
Sanya J Thomas[SUP] 1 2 3 4 [/SUP], Natalia E Castillo Almeida[SUP] 5 [/SUP], Claire Bocchini[SUP] 6 [/SUP], Caitlin Brammer[SUP] 7 8 [/SUP], Guy Brock[SUP] 9 [/SUP], Abigail Calimaran[SUP] 10 [/SUP], Ronald Dallas[SUP] 11 [/SUP], Kevin J Downes[SUP] 10 12 [/SUP], Jose A Ferrolino[SUP] 11 [/SUP], Md Rejuan Haque[SUP] 9 [/SUP], Anna R Huppler[SUP] 13 [/SUP], Ishminder Kaur[SUP] 14 [/SUP], Madan Kumar[SUP] 15 [/SUP], Meghan Landry[SUP] 16 [/SUP], Stacee Lerret[SUP] 13 [/SUP], Gabriela M Maron[SUP] 11 [/SUP], Timothy D Minniear[SUP] 17 18 [/SUP], William J Muller[SUP] 19 20 [/SUP], Flor M Munoz[SUP] 21 [/SUP], William R Otto[SUP] 7 8 [/SUP], Kerrigan Perkins[SUP] 7 8 [/SUP], Elizabeth H Ristagno[SUP] 22 [/SUP], Anna Sharova[SUP] 10 12 [/SUP], Katherine Siegel[SUP] 13 [/SUP], Eunkyung Song[SUP] 1 2 [/SUP], Marion Jose Valladares[SUP] 23 [/SUP], Natasha A Wilson[SUP] 5 [/SUP], Allison Yoshida[SUP] 5 24 [/SUP], Masako Shimamura[SUP] 1 2 25 [/SUP]
Affiliations
- PMID: 42596081
- DOI: 10.1111/tid.70303
Background: While vaccination is a key strategy to mitigate the severity of coronavirus disease 2019 (COVID-19) in children, the risk factors for symptomatic, medically attended (hereon referred to as "symptomatic") COVID-19 and the impact of vaccination are not well defined among pediatric solid organ transplant recipients (PSOTR).
Methods: PSOTR aged six months through 21 years at 11 centers in the Pediatric Infectious Diseases Transplant Network (PIDTRAN) were analyzed retrospectively for symptomatic COVID-19 between July 2021 and May 2023. Using a Cox proportional hazards model, risk factors associated with COVID-19-associated hospitalization, in-hospital oxygen use, mechanical ventilation, and the impact of COVID-19 vaccination were analyzed.
Results: Of 1370 PSOTR, 410 (29%) had symptomatic COVID-19 infection. Among those with symptomatic infection, 115 (28%) were hospitalized, 35 required in-hospital oxygen, and three required mechanical ventilation. In the study, 45% were unvaccinated against COVID-19. Compared to unvaccinated PSOTR, incompletely vaccinated PSOTR had 56% lower hazard (95% CI 0.26, 0.72, p = 0.001) of COVID-19-associated hospitalization whereas completely vaccinated did not have a statistically significant difference in hazard of hospitalization. Receipt of at least one dose of the bivalent vaccine was also associated with 92.5% lower hazard (95% CI 0.010, 0.55, p = 0.011) of hospitalization. Risk factors for hospitalization included chronic kidney disease, underlying heart disease, neurodevelopmental delay, and lymphocytopenia.
Conclusions: Most PSOTR with symptomatic COVID-19 did not require hospitalization or respiratory support. Several comorbidities and lymphocytopenia are associated with severe COVID-19 in PSOTR. COVID-19 vaccination, mostly, protected PSOTR against COVID-19-associated hospitalization, but vaccine uptake among PSOTR was low.
Keywords: COVID‐19; pediatrics; transplant; vaccines.