Abstract
Solid organ transplant (SOT) recipients are at high risk for severe coronavirus disease 2019 (COVID-19). Studies suggest that early intervention with monoclonal antibody (MAB) treatment directed against the SARS-CoV-2 spike protein may reduce the risk of emergency department visits or hospitalization for COVID-19, especially in high-risk patients. Herein, we describe our single-center experience of 93 SOT (50 kidney, 17 liver, 11 lung, nine heart, and six dual-organ) recipients with mild to moderate COVID-19 who were treated with bamlanivimab or casirivimab-imdevimab per emergency use authorization guidelines. Median age of recipients was 55 [(Interquartile range) 44-63] years, and 41% were diabetic. Median time from transplant to MAB was 64 (IQR 24-122) months and median time from the onset of COVID-19 symptoms to the infusion was 6 (IQR 4-7) days. All patients had a minimum 30 days of study follow-up. The 30-day hospitalization rate for COVID-19-directed therapy was 8.7%. Infusion-related adverse events were rare and generally mild. Biopsy-proven organ rejection occurred in two patients, and there were no graft losses or deaths. A comparator group of 72 SOT recipients diagnosed with COVID-19 who were eligible but did not receive MAB treatment had a higher 30-day hospitalization rate for COVID-19-directed therapy (15.3%), although this difference was not statistically significant, after adjustment for age (Odds Ratio 0.49 [95% Confidence Interval 0.18-1.32], p = 0.16). Our experience suggests that MAB treatment, with respect to the available MAB formulations and circulating viral variants present during our study period, may provide favorable outcomes for mild to moderate COVID-19 in SOT recipients.
Keywords: COVID-19; SARS-CoV-2; bamlanivimab; casirivimab-imdevimab; kidney transplant; monoclonal antibodies; solid organ transplant.
【저자키워드】 COVID-19, SARS-CoV-2, monoclonal antibodies, bamlanivimab, kidney transplant, casirivimab-imdevimab, solid organ transplant, 【초록키워드】 Treatment, coronavirus disease, Coronavirus disease 2019, therapy, Hospitalization, monoclonal antibody, lung, risk, Intervention, Organ transplant, outcome, monoclonal antibodies, Emergency use authorization, bamlanivimab, Spike protein, Moderate COVID-19, emergency department, kidney, adverse events, Viral, Transplant, Casirivimab, Imdevimab, SARS-CoV-2 spike protein, adverse event, Patient, Mild, Viral variants, age, Follow-up, COVID-19 symptoms, liver, patients, kidney transplant, solid organ transplant, monoclonal, High-risk patients, infusion, deaths, biopsy, solid organ, SOT, high risk, COVID-19 symptom, mild to moderate, Mild to moderate COVID-19, confidence, Diabetic, confidence interval, recipients, severe coronavirus disease, median time, median age, two patients, study period, single-center, Comparator group, recipient, organ, rejection, circulating viral variants, occurred, nine, treated, reduce, statistically significant, interval, Ratio, receive, circulating viral variant, diagnosed with COVID-19, eligible, generally mild, IQR, Solid, the SARS-CoV-2, 【제목키워드】 antibody treatment, recipient,