Risk Factors for Coronavirus Disease 2019 Hospitalization and Vaccination Impact Among Pediatric Solid Organ Transplant Recipients in the United States
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.
Authors
- Natalia E. Castillo Almeida (ORCID: https://orcid.org/0000-0002-9904-7137)
- Ishminder Kaur (ORCID: https://orcid.org/0000-0002-1759-8788)
- Masako Shimamura (ORCID: https://orcid.org/0009-0008-9952-351X)
- Sanya J. Thomas (ORCID: https://orcid.org/0000-0003-1607-9537)
- Anna R. Huppler (ORCID: https://orcid.org/0000-0003-1263-6623)
- Eunkyung Song
- Stacee Lerret
- Madan Kumar (ORCID: https://orcid.org/0000-0003-0866-8681)
- Allison Yoshida
- Meghan Landry
- Kerrigan Perkins
- Marion Valladares
- Ronald Dallas
- Anna Sharova
- Kevin J. Downes
- Md Rejuan Haque (ORCID: https://orcid.org/0000-0002-0582-5269)
- Katherine Siegel
- Caitlin Brammer
- Timothy D. Minniear
- Claire Bocchini
- Jose A. Ferrolino
- Natasha A. Wilson
- Gabriela M. Maron
- Elizabeth H. Ristagno
- Abigail Calimaran
- Guy Brock
- Flor M. Munoz
- William R. Otto
- William J. Muller
Institutions
- Rocky Vista University (US)
- Northwestern University (US)
- Children's Hospital of Wisconsin (US)
- Cincinnati Children's Hospital Medical Center (US)
- Lurie Children's Hospital (US)
- Morgan Stanley Children's Hospital (US)
- St. Jude Children's Research Hospital (US)
- Nationwide Children's Hospital (US)
- Children's Hospital of Philadelphia (US)
- University of Tennessee Health Science Center (US)
- University of California, Los Angeles (US)
- Baylor College of Medicine (US)
- University of California System (US)
- University of Illinois Chicago (US)
- University of Chicago (US)
- Mayo Clinic in Florida (US)
- Texas Children's Hospital (US)
- Rocky Mountain MS Center (US)
- Le Bonheur Children's Hospital (US)
- The Ohio State University (US)
- University of Nebraska Medical Center (US)
- Columbia University (US)
- University of Pennsylvania (US)
- University of Cincinnati Medical Center (US)
Publication Details
- Journal
- Transplant Infectious Disease
- Published
- 2026-08-13
- DOI
- https://doi.org/10.1111/tid.70303
- Primary Topic
- SARS-CoV-2 and COVID-19 Research
- Type
- article
- Field-Weighted Citation Impact
- 0.00