ESPN 54th Annual Meeting

ESPN 2022


 
One-year follow-up data of arterial abnormalities identified in kidneys transplanted into children during the first COVID-19 pandemic wave
MATHILDE GRAPIN 1 LAURELINE BERTELOOT 2 ROMAIN BERTHAUD 1 SARAH TEMMAM 3 CECILE LOZACH 2 MARINA AVRAMESCU 1 ELISA ZANELLI 2 THOMAS BLANC 4 CARMEN CAPITO 4 CHRISTOPHE CHARDOT 4 SABINE SARNACKI 4 NICOLAS GARCELON 1 FLORENCE LACAILLE 4 MARINA CHARBIT 1 MYRIAM PASTURAL 1 MARION RABANT 1 NATHALIE BODDAERT 2 MARIANNE LERUEZ-VILLE 3 MARC ELOIT 3 ISABELLE SERMET-GAUDELUS 3 LAURENE DEHOUX 1 OLIVIA BOYER 1

1- NéPHROLOGIE PéDIATRIQUE, CENTRE DE RéFéRENCE MARHEA, HôPITAL NECKER ENFANTS MALADES, APHP, INSTITUT IMAGINE, UNIVERSITé DE PARIS, PARIS, FRANCE
2- IMAGERIE PéDIATRIQUE, HôPITAL NECKER ENFANTS MALADES, APHP, INSTITUT IMAGINE, UNIVERSITé DE PARIS, PARIS, FRANCE
3- LABORATOIRE DéCOUVERTE DE PATHOGèNES, INSTITUT PASTEUR, PARIS, FRANCE
4- CHIRURGIE PéDIATRIQUE, HôPITAL NECKER ENFANTS MALADES, APHP, INSTITUT IMAGINE, UNIVERSITé DE PARIS, PARIS, FRANCE
 
Introduction:

 Graft artery stenosis can have a significant short- and long-term negative impact on kidney graft function. We previously reported an unusual number of graft arterial anomalies following kidney transplantation (KTx) in children during the first COVID-19 pandemic wave (Berteloot et al. Am J Transplant21). We report herein the one-year follow-up of these patients.

Material and methods:

In this retrospective study, we included all children who received a KTx at our center from February-July 2020.

Results:

Among the 9 children who received a KTx at our center between February and July 2020 (8 boys, median age 10 years (3-17)), 8 presented Doppler features suggesting arterial stenosis, with an unusual extensive pattern (Fig.1) after a median delay of 13 days (8-113). For comparison, persistent spectral Doppler arterial anomalies were observed in only 5% of children following KTx at our center over the previous 5-year period, and were all focal anastomotic stenoses. In addition, five children had lymphoceles, which required surgical management as compared to only one patient in the 5 previous years (1%).  We retrospectively diagnosed SARS-CoV-2 infection in 6/8 children with arterial stenosis on serologies performed at D0, including one boy with a history of positive RT-PCR 120 days before KTx. None of the patients had reported any symptom suggestive of COVID-19. The remaining 2 patients had received a graft from an asymptomatic deceased adolescent donor with a positive serology at D0. These data led us to suspect immune postviral graft vasculitis, triggered by SARS-CoV-2.

At one year post-transplantation, the outcome was favorable in the 8 isolated KTx recipients. 4/8 children had normal blood pressure and 4 had controlled high blood pressure on mono or bitherapy. Doppler anomalies had resolved in 5/8 and persisted in 3/8 with a trend for improvement of peak systolic velocities and no severe consequences on kidney function and histology. Indeed, the median GFR was 91ml/min/1.73m² (65-129), with unspecific and mild lesions on 4/8 protocol kidney biopsies (IFTA 1 or Cpt 1). One liver-kidney graft recipient had persistent hypertension and diffuse irregular inflammatory parietal thickening of the whole vascular graft associated with a parietal thrombus upstream of the birth of the 2 hepatic arteries

Conclusions:

Our case series suggests a risk of postviral kidney graft vasculitis in children with a recent SARS-CoV-2 infection in the recipient or donor. Pre-transplant vaccination against COVID-19 is mandatory in children>5 years and their kidney donor candidates at our center. We also strongly recommend vaccination of all people aged >5 years in the household.