Early Report on COVID-19 Infections in Pediatric Heart Transplant Recipients and Candidates

PURPOSE: Reports focused on adult heart transplant (HT) recipients with COVID-19 suggest an increased risk of severe disease. It is unclear if this holds true for pediatric HT patients, given the reported milder course of illness in children in general with COVID-19. We sought to rapidly implement a system for multi-center data collection on pediatric HT recipients and candidates, with the aim of describing the patient population and infection related outcomes. METHODS: The Pediatric Heart Transplant Society (PHTS) is a multi-center collaboration whose main goal is to improve the outcomes of children who are listed and undergo HT. The society consists of pediatric HT centers in North America (n=53), UK (n=2), and Brazil (n=1). In response to the pandemic, PHTS developed a web-based platform to collect COVID-19 specific data in pediatric HT candidates and recipients. Non-PHTS centers were also invited to submit data. Data fields included pre-and post-HT patient characteristics, presumed vs. documented infection, need for hospitalization (including ICU and ventilator use), treatments administered, and 30-day outcome (death, resolution, sequelae, ongoing treatment). RESULTS: Data collection was initiated on 4/30/20. As of 9/28/20, there were 72 patients (7 pre-HT and 65 post-HT, median age 13 years) reported from 27 centers. Of these, 67 were PCR+ by nasal swab and 5 were presumed positive. Complete data with 30-day follow-up was available for 60 patients (7 pre and 53 post HTx). Hospitalization was common and occurred in 71% of the pre-HT and 32% of the post HTx patients. Of the pre-Tx patients, 43% required ICU and 14% were ventilated. In the post HTx group, 13% required ICU and 4% were ventilated. At 30 days a majority of pre-Tx had resolution of symptoms (n=6/7). Among post HTx patients, resolution occurred in 87%% (46/53) with 1 death at 30 days. CONCLUSION: The PHTS remains the most robust source of data on pediatric HT and this effort shows the adaptability of the registry. Although likely limited by reporting bias, these data represent the first known report of characteristics and early outcomes for pediatric HT candidates and recipients with COVID-19. As data collection continues, we aim to better understand the characteristics of patients with more severe disease in order to improve risk characterization and decrease the knowledge gap that currently exists in this unique population.