A CURRENT VIEW OF SARS-COV-2 VACCINE POLICIES AMONGST PEDIATRIC RENAL TRANSPLANT CENTERS AND RELATIONSHIPS TO STATE POLICY

Objectives: According to US Renal Data System reports, first-year mortality rates in children with ESRD were lowest after renal transplantation, with a median time on the kidney-alone transplant waitlist of 196 days in 2019. Typically, children eligible for transplant will receive standard immunizations up to the time of transplant and are instructed to avoid live-virus vaccinations post-operatively. Since the first Covid-19 vaccine was approved for emergency use in adolescents 12-15 years of age in May 2021, additional trials have led to the most recent expansion to include children ages 6 months-5 years old. Despite limited data, the two available vaccines have shown promise with favorable adverse effect profiles and similar effectiveness to that seen in young adults. However, skepticism remains and has resulted in less adoption in both ill and healthy children, compared to their adult counterparts. The SARS CoV-2 pandemic has introduced significant heterogeneity to vaccination practices in children, as transplant centers develop policies to address the vaccination status of pediatric patients.

The aim of our study was to evaluate the variation of pediatric renal transplant centers’ Covid-19 vaccination policies and the relationship to their state policies as of September 2022.

Methods: Using the most recent data (August 2022) provided by the National Conference of State Legislatures and the National Academy for State Health Policy, we identified each state’s Covid-19 vaccination policies. We then contacted by phone each of the 100 US centers that performed a pediatric renal transplant (included deceased and living donors) between January-December 2021, according to the Scientific Registry of Transplant Recipients.

Results: Of the 36 centers that responded, 23 (63.9%) recommend vaccination, 7(19.4%) require vaccination prior to listing, and 6 (16.7%) require vaccination prior to transplant, but allow inactive listing prior to vaccination. With regards to policy, 17 states have legislation in place that prohibits vaccination status as a means for access to government services. 15/23 (65%) centers that do not require vaccination are located outside the aforementioned states, which demonstrates that state policy is not the primary factor in determining individual program requirements.

Conclusion: The current institutional specific Covid-19 vaccination requirements with regards to pediatric renal transplantation vary significantly throughout the country, without a clear reason for difference. This lack of standard vaccination practice may create an excess mortality risk in children who are unable to be listed and transplanted expeditiously.