Introduction: Pediatric liver transplant recipients are of main concern during COVID-19 pandemia, due to their chronic immunosuppressed state. Moreover, there was a need to re-organize pediatric and transplant care during the most severe time of pandemia. Current data are sparse and heterogeneous thus the aim of this study was to assess the outcome of COVID-19 infections in pediatric transplant recipients and its impact on the quality of care.   

Methods: We performed a cross-sectional study recruiting patients in the first mid-year of 2021, during the first wave of COVID-19 pandemia before introduction of vaccinations for children. IgG and IgM anti COVID-19 antibodies were performed in all patients so as to outline patients after COVID-19 infection. Detailed clinical history was collected, including symptoms up to 6 months backwards. Patients and parents were also asked to complete the questionaries including assessment of quality of live (PedsQL) and adaptations on medical care system during pandemia.  

Redults: We involved 116 children after liver transplantation and found positive antibodies in 38 (33%) of patients. No severe course of COVID infection was reported and most patients had asymptomatic course of disease (68%). Among symptomatic patients (32%) the most common symptoms were fever, cough, loss of taste and smell, dysponea and abdominal pain. 97% of patients had no changes in immunosuppression during pandemia. According to the questionaries basic pediatric care worsened in the opinion of 56% parents from the beginning of COVID-19 pandemia mainly due to the worse access to the general physicians and pediatricians. The quality of transplant care did not change significantly in the opinion of 78% of responders and 36% of visits had to be delayed and re-scheduled. Telemedicine was a part of adjustments in transplant specialist care, most patients did not express their opinions on their quality but 34% send positive feedback. Most of the concerns of parents resulted from the lack of physical examination (33%) during tele-visit, and 81% asked to have next visit on site. 

Conclusion: Children after liver transplantation seem not to be at higher risk of severe course and complicatons of COVID-19 infection. Reduction of immunosuppression is not recommended in the majority of cases. Pandemia had poor impact on the quality of pediatric care. Telemedicine proved to be valuable method so as to secure continuation of transplant care but had limitations resulting mainly from the lack of direct contact and physical examination.