Investigation of the effect of the COVID-19 pandemic period on pediatric patients with liver transplant

Purpose: The aim of our study is to investigate the risks of anxiety, obesity and tissue rejection in children with liver transplantation during the COVID-19 pandemic. In addition, during the pandemic period, changes in children's school achievement, diet and physical activity changes were evaluated. Materials and methods: 69 patients who wanted to participate in the study were included in our study, out of 86 patients aged 0-18 years who had a liver transplant at least three months before the date of March 2020, when the pandemic was declared. In our study, a descriptive questionnaire was applied in which patients' drug compliance, frequency of rejection, follow-up periods after transplantation, height, weight, body mass index, frequency of rejection attacks, presence of transplantation-related complications, drugs used, and follow-up and treatment information during the pandemic period were questioned. In addition, the SCARED (Self-report for Childhood Anxiety Related Disorders) anxiety scoring scale was used for the assessment of anxiety with COVID-19 symptom and contact questionnaires using the recommendations of the Ministry of Health. Results: Of the 69 patients included in the study, 36 (52.2%) were male and 33 (47.8%) were female. The mean age of the patients was calculated as 10.69±4.77 years. The mean follow-up period of the patients was 70.97±40.91 months. The mean time between transplantation and diagnosis was 34.79±43.34 months. 53 (76.8%) of the patients live in the city and 16 (23.2%) live in the countryside. The most common indication for transplantation is biliary atresia (18.8%). The most frequently used drug by the patients was tacrolimus (85.5%). The diet of 84.1% of the patients did not change. A decrease in school success was observed in 40.6% of them. There was an increase in the screen exposure times of 65.2% of the patients compared to the pre-pandemic period. During the pandemic period, only one of the patients had symptoms of fever. 14 patients were evaluated with the COVID-19 PCR test and all were found to be negative. During the pandemic period, there was a significant decrease in the number of outpatient clinic applications and the need for drug revision (p<0.05). There was a significant increase in the body mass index measurements of the patients during the pandemic period (p<0.05). A relationship was found between the increase in screen exposure time and the increase in body mass index, but this relationship was not statistically significant (p>0.05). As the follow-up period of the patients increased, it was determined that the need for drug revision and the frequency of rejection attacks decreased (p<0.05). As the age and follow-up period of the patients increased, their scores on the generalized anxiety disorder scale increased (p<0.05). As the follow-up period and body mass index of the patients increased, the scores they got from the separation anxiety scale decreased (p<0.05). As the age increased, the scores obtained from the social anxiety scale increased (p<0.05). Conclusion: Only one of our patients had a fever symptom and the COVID-19 test was negative. The fact that our patients are asymptomatic suggests that immunosuppression may be protective against COVID-19. Patients' drug compliance was better during the pandemic period. Medication revision needs are significantly reduced. In general, drug compliance was found to be better during the pandemic period. The frequency of rejection attacks decreased due to drug compliance and exposure of patients to fewer infections during the quarantine period. It was observed that the drug compliance was better as the follow-up period increased. However, it has been observed that quarantine practices cause a decrease in physical activity and an increase in screen exposure time. As a result, it has been determined that patients are more prone to weight gain. Anxiety was detected in a very small part of the patients included in the study. Continuing the outpatient follow-up in its current state during the COVID-19 pandemic process, not regulating nutrition, but creating exercise programs that patients can apply at home, and continuing to follow their height and weight regularly will be beneficial in terms of minimizing the risk of obesity, anxiety and anxiety. Key words: liver transplant, COVID-19, pandemic,post transplant follow up obesity, anxiety