Table 2.

Suggested Risk Stratification for Pediatric Kidney Transplant Recipients Who May Be at Increased Risk for Severe COVID-19.

	High risk	Moderate risk	Low risk
Degree of immunosuppression	High level of immunosuppression: • Within initial 6 months post-kidney transplant • Undergoing treatment for acute rejection (high-dose steroids, thymoglobulin, rituximab)	Stable and tapering level of immunosuppression: • Within 6-12 months post-kidney transplant • Within 3-6 months post-treatment for acute rejection OR Increased level of immunosuppression (ie, for treatment of donor-specific antibodies)	Stable and low level of immunosuppression: • Beyond 1st year post-transplant on low baseline immunosuppression • Beyond 6 months post-treatment for acute rejection
Medical stability	Unstable allograft function with increased likelihood for increasing level of immunosuppression (ie, for acute rejection, donor-specific antibodies)	Stable and improving allograft function, on tapering level of immunosuppression Low likelihood for need to increase level of immunosuppression	Stable allograft function
Comorbidities	Unstable, multiple, or severe comorbidities: • Obesity • Diabetes mellitus • Chronic lung or cardiac disease • Neurologic and neurodevelopmental conditions • Rheumatologic diseases • Inflammatory bowel disease • Inherited metabolic disorders • Hematologic disorders • Severe liver diseases • Severe kidney diseases Concurrent immunocompromising condition (ie, treatment of malignancy/PTLD, primary immunodeficiency) Conditions suggesting increased net state of immunosuppressed state (ie, lymphopenia, concomitant CMV)	Stable or improving stability of comorbidities	No comorbidities
Ability to adhere to enhanced precautions in school	Unable to consistently adhere to optimal physical distancing, frequent hand hygiene practices, and/or wearing face covering	Unable to consistently adhere to optimal physical distancing, frequent hand hygiene practices, or wearing a face covering BUT otherwise considered “low risk”	Able to consistently adhere to optimal physical distancing, frequent hand hygiene practices, and wearing a face covering
Local COVID-19 activitya	High level of active community spread	Moderate level of active community spread	Stable and low level of active community spread

Note. COVID-19 risk stratification for pediatric kidney transplant recipients based on risk factors for severe COVID-19 in adults, emerging risk factors for severe COVID-19 in children, and extrapolation of risk factors from other respiratory viruses. CMV = cytomegalovirus.

^aDegree of COVID-19 activity (high, moderate, low) as defined by local public health authorities.