Abstract
Background: Morbidity and mortality associated with coronavirus disease 2019 (COVID-19) infection in kidney transplant recipients are high and early outpatient interventions to prevent progression to severe disease are needed. SARS-CoV-2 neutralizing mAbs, including bamlanivimab and casirivimab-imdevimab, received emergency use authorization in the United States in November 2020 for treatment of mild to moderate COVID-19 disease.
Methods: We performed a retrospective analysis of 27 kidney transplant recipients diagnosed with COVID-19 between July 2020 and February 2021 who were treated with bamlanivimab or casirivimab-imdevimab and immunosuppression reduction. We additionally identified 13 kidney transplant recipients with COVID-19 who had mild to moderate disease at presentation, who did not receive mAbs, and had SARS-CoV-2 serology testing available.
Results: There were no deaths or graft failures in either group. Both infusions were well tolerated. Four of the 27 patients treated with mAbs required hospitalization due to COVID-19. Four of 13 patients who did not receive mAbs required hospitalization due to COVID-19. Patients who received mAbs demonstrated measurable anti-SARS-CoV-2 IgG with angiotensin-converting enzyme 2 (ACE2) receptor blocking activity at the highest level detectable at 90 days postinfusion, whereas ACE2 blocking activity acquired from natural immunity in the mAb-untreated group was weak.
Conclusions: Bamlanivimab and casirivimab-imdevimab combined with immunosuppression reduction were well tolerated and associated with favorable clinical outcomes in kidney transplant recipients diagnosed with mild to moderate COVID-19.
Keywords: COVID-19; SARS-CoV-2; immunosuppression; kidney transplant; monoclonal antibodies; transplantation.
【저자키워드】 COVID-19, SARS-CoV-2, Immunosuppression, monoclonal antibodies, kidney transplant, transplantation, 【초록키워드】 Treatment, coronavirus disease, Coronavirus disease 2019, ACE2, Mortality, Hospitalization, Infection, Immunosuppression, Intervention, progression, monoclonal antibodies, angiotensin-converting enzyme 2, Emergency use authorization, bamlanivimab, Moderate COVID-19, COVID-19 disease, Clinical outcome, kidney, Casirivimab, Imdevimab, anti-SARS-CoV-2 IgG, serology testing, morbidity, Patient, death, Retrospective analysis, Mild, Neutralizing, receptor, United States, disease, kidney transplant, mAbs, monoclonal, mAb, kidney transplant recipient, Angiotensin-converting enzyme, kidney transplant recipients, angiotensin, natural immunity, severe disease, transplantation, mild to moderate, Mild to moderate COVID-19, reduction, mild to moderate disease, moderate disease, enzyme, mild to moderate COVID-19 disease, blocking activity, Prevent, highest, performed, the United State, detectable, diagnosed, required, treated, demonstrated, receive, diagnosed with COVID-19, patients treated, with COVID-19, 【제목키워드】 Transplant, recipient,