Management of Pediatric Kidney Transplant Patients During the COVID-19 Pandemic: Guidance From the Canadian Society of Transplantation Pediatric Group

Chia Wei Teoh; Marie-Michele Gaudreault-Tremblay; Tom D Blydt-Hansen; Aviva Goldberg; Steven Arora; Janusz Feber; Valerie Langlois; Michelle Ruhl; Veronique Phan; Catherine Morgan; Philip Acott; Lorraine Hamiwka

doi:10.1177/2054358120967845

Management of Pediatric Kidney Transplant Patients During the COVID-19 Pandemic: Guidance From the Canadian Society of Transplantation Pediatric Group

Can J Kidney Health Dis. 2020 Nov 13:7:2054358120967845. doi: 10.1177/2054358120967845. eCollection 2020.

Authors

Chia Wei Teoh^{1

2

3}, Marie-Michele Gaudreault-Tremblay^{4

5}, Tom D Blydt-Hansen^{6

7}, Aviva Goldberg^{8

9}, Steven Arora^{10

11}, Janusz Feber^{12

13}, Valerie Langlois^{1

2

3}, Michelle Ruhl^{14

15}, Veronique Phan^{16

17}, Catherine Morgan^{18

19}, Philip Acott^{20

21}, Lorraine Hamiwka^{22

23}

Affiliations

¹ Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
² Transplant & Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada.
³ Department of Paediatrics, University of Toronto, ON, Canada.
⁴ Division of Nephrology, Montreal Children's Hospital, QC, Canada.
⁵ Department of Paediatrics, McGill University, Montreal, QC, Canada.
⁶ Division of Nephrology, BC Children's Hospital, Vancouver, Canada.
⁷ Department of Paediatrics, The University of British Columbia, Vancouver, Canada.
⁸ Division of Nephrology, The Children's Hospital of Winnipeg, MB, Canada.
⁹ Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Canada.
¹⁰ Division of Nephrology, McMaster Children's Hospital, Hamilton, ON, Canada.
¹¹ Department of Paediatrics, McMaster University, Hamilton, ON, Canada.
¹² Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Canada.
¹³ Department of Paediatrics, University of Ottawa, ON, Canada.
¹⁴ Division of Nephrology, Jim Pattison Children's Hospital, Saskatoon, SK, Canada.
¹⁵ Department of Paediatrics, University of Saskatchewan, Saskatoon, Canada.
¹⁶ Division of Nephrology, CHU Sainte-Justine, Montreal, QC, Canada.
¹⁷ Department of Paediatrics, University de Montreal, QC, Canada.
¹⁸ Division of Nephrology, Stollery Children's Hospital, Edmonton, AB, Canada.
¹⁹ Department of Paediatrics, University of Alberta, Edmonton, Canada.
²⁰ Division of Nephrology, IWK Health Centre, Halifax, NS, Canada.
²¹ Department of Paediatrics, Dalhousie University, Halifax, NS, Canada.
²² Division of Nephrology, Alberta Children's Hospital, Calgary, Canada.
²³ Department of Paediatrics, University of Calgary, AB, Canada.

Abstract

Purpose of the program: To provide guidance on the management of pediatric kidney transplant patients during the COVID-19 pandemic.

Sources of information: Program-specific documents, preexisting, and related to COVID-19; documents from provincial, national, and international kidney transplant societies/agencies and organ procurement agencies; national and international webinars, including webinars that we hosted for input and feedback; with additional information from formal and informal review of published academic literature.

Methods: Challenges in the care of pediatric kidney transplant patients during the COVID-19 pandemic were highlighted within the Canadian Society of Transplantation (CST) Pediatric Group. It identified pediatric kidney transplant nephrologists (including a pediatric nephrologist ethicist) across the country and formed a workgroup. The initial guidance document was drafted and members of the workgroup reviewed and discussed all suggestions in detail via e-mail and virtual meetings. Disagreements were resolved by consensus. The document was reviewed by the CST Kidney Transplant Working Group, by the Canadian Society of Nephrology (CSN) COVID-19 Rapid Response Team (RRT), and an infectious disease expert. The suggestions were presented at an interactive webinar sponsored by CSN in collaboration with the CST and Canadian Association of Pediatric Nephrologists (CAPN), and attended by pediatric kidney health care professionals for further peer input. Final revisions were made based on feedback received. CJKHD editors reviewed the parallel process peer review and edited the manuscript for clarity.

Key findings: We identified 8 key areas of pediatric kidney transplant care that may be affected by the COVID-19 pandemic: (1) transplant activity, (2) outpatient clinic activity, (3) monitoring, (4) multidisciplinary care, (5) medications (immunosuppression and others), (6) patient/family education/support, (7) school and employment, and (8) management of pediatric kidney transplant patients who are COVID-19 positive. We make specific suggestions for each of these areas.

Limitations: A full systematic review of available literature was not undertaken for the sake of expediency in development of this guideline. There is a paucity of literature to support evidence-based recommendations at this time. Instead, these guidelines were formulated based on expert opinion derived from available knowledge/experience and are subject to the biases associated with this level of evidence. The parallel review process that was created to expedite the publication of this work may not be as robust as standard arms' length peer review processes.

Implications: These recommendations are meant to serve as a guide to pediatric kidney transplant directors, clinicians, and administrators for providing the best patient care in the context of limited resources while protecting patients and health care providers wherever possible by limiting exposure to COVID-19. We recognize that recommendations may not be applicable to all provincial/local health authority practices and that they may not be delivered to all patients given the time and resource constraints affecting the individual provincial/local health jurisdiction.

Keywords: kidney transplantation; pediatric; pediatric kidney transplant; pediatric nephrology.