Boettler T, Newsome PN, Mondelli MU, et al.. with autoimmune liver disease or in LT recipients (109,118,119). Statement: Ther em e are insufficient data to recommend for or against the use of specific antivirals or immunomodulatory agents for the treatment of COVID-19 in children with liver disease. /em (Agreement: 4/4/4/4/4/4/3/3/3) em 11. SARS-CoV2 vaccination should be recommended for all children 12C17?years of age with chronic liver disease, including autoimmune liver disease on immunosuppressive therapies, patients with cirrhosis, Diflumidone transplant recipients, those on the waiting list for LT and their caregivers. The same recommendation applies to younger children in which safety is currently being evaluated. /em (Agreement: 4/4/4/4/4/4/4/4/3) em 12. Future studies are needed to determine COVID-19 vaccine immunogenicity in children with chronic liver disease and LT recipients. /em (Agreement: 4/4/4/4/4/4/4/4/4) Therapeutic Approach to Multisystem Inflammatory Syndrome in Children Treatments for MIS-C consist primarily of supportive care, antiplatelet and anticoagulation therapy and care directed against the underlying inflammatory process. Supportive measures are lifesaving and include fluid resuscitation, inotropic and respiratory support up to extracorporeal membranous oxygenation. Of note, therapies for MIS-C, including aspirin, enoxaparin and immunomodulatory therapies (intravenous immunoglobulins and steroids) can cause drug-induced liver injury. Anakinra and tocilizumab (recombinant human interleukin-1 and -6 receptors antagonists, respectively) may rarely cause clinically apparent liver injury and are more frequently associated with elevated serum aminotransferases (143). Social Distancing and Infection Prevention Preventive strategies are of paramount importance, particularly for children with chronic liver disease or LT recipients (144); however, the social behaviors recommended for personal safety and infection control do not differ from the general populations. The different gradations of social distancing, use of masks and face coverings, school openings, sport events and gatherings, and Diflumidone travelling are regulated by the local authorities based on epidemiological considerations. Statement: em 13. Children with CLD or LT recipients should follow similar social behavior to the general population regarding social distancing, mask-wearing and hand washing. /em (Agreement: 4/4/4/4/4/4/4/4/3) CONCLUSIONS The present document aims at providing evidence-based guidance to health care providers about liver involvement in children with SARS-CoV2 infection and recommendations for the management of children with Diflumidone underlying liver disease and LT recipients. These populations are generally not at substantial risk of severe SARS-CoV2 infection, though critical attention is warranted for children who: present in ALF, have end-stage liver disease and are listed for transplantation as acute decompensation has been reported, or who are in the immediate post-transplant period with the highest degree off immunosuppressive burden. As COVID-19 vaccine distribution is underway, further studies PP2Bgamma are required to understand immunogenicity in LT recipients and children with CLD on immunosuppressive therapies. The resulting position statements in this document are primarily derived from expert review and summarize evidence from adults Diflumidone with cirrhosis or solid organ transplantation and the general pediatric population in addition to data from pediatric solid organ transplant recipients and children with CLD. Further studies are needed to better guide SARS-CoV2 therapeutics and management, inform timing of LT following SARS-CoV2 infection, understand COVID-19 vaccine immunogenicity and explore other special considerations in children with CLD or who have undergone pediatric LT. Footnotes The authors report no conflicts of interest. Drs Emanuele Nicastro and Noelle H. Ebel contributed equally to this study; Mercedes Martinez, and Giuseppe Indolfi contributed equally to this study. Disclaimer: ESPGHAN and SPLIT are not responsible for the practices of physicians and provide guidelines and.
