Use of Monoclonal Antibodies for Treatment of Solid Organ Transplant Recipients with COVID-19: A Single Center Experience

S. Anjan¹, C. Vu², A. Vega², M. Maxam², J. Bini Viotti³, Y. Natori¹, J. Simkins¹, A. Khatri³, A. Mattiazzi¹, R. Vianna¹, J. Cienki², L. Lee², G. Guerra¹, L. Abbo²

¹Miami Transplant Institute, Miami, FL, ²Jackson Health System, Miami, FL, ³University of Miami Miller School of Medicine, Miami, FL

Meeting: 2022 American Transplant Congress

Abstract number: 1342

Keywords: COVID-19, Kidney transplantation, Liver transplantation, Monoclonal antibodies

Topic: Clinical Science » Infection Disease » 24 - All Infections (Excluding Kidney & Viral Hepatitis)

Session Information

Session Name: All Infections (Excluding Kidney & Viral Hepatitis) III

Session Type: Poster Abstract

Date: Monday, June 6, 2022

Session Time: 7:00pm-8:00pm

Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: The risk of severe COVID-19 requiring hospitalization and death is higher in solid organ transplant recipients (SOTr). There remains limited data on the use of monoclonal antibodies and long-term outcomes in SOTr.

*Methods: This is a retrospective study conducted at Jackson Health System-Miami Transplant Institute in SOTr with mild-moderate COVID-19, from November 2020 to October 2021. Bamlanivimab was used initially for outpatients with mild to moderate COVID-19 but switched to casirivimab/imdevimab on March 1, 2021, due to rising prevalence of SARS-CoV-2 variants in the Miami-Dade area. Outcomes assessed included emergency department visits, hospitalizations, allograft rejection, and death.

*Results: Ninety-two patients were treated, most commonly with casirivimab/imdevimab (74%). The median age was 51 (range, 18-81) years, with 61% male and 60% Hispanic ethnicity. Transplanted organs included 68 kidney (74%), 10 liver (10.8%), 10 heart (10.8%), and 7 lung (7.6 %). Forty-two (45.6%) had a vaccine breakthrough infection, of which 34 (80.9%) were during the delta variant predominance.. The median time from positive SARS-CoV-2 test to administration of monoclonal antibody was 1 (range, 0 – 10) day. Anti-metabolite agents were decreased or held in 54.3% of cases. Median follow-up was 116 (range, 19 – 358) days. Five (5.8%) patients had an emergency department visit, 26 (28.2%) were hospitalized; of which 11 (42%) were due to worsening COVID-19 symptoms within 28-days of infusion. 63.6% (7/11) required supplemental oxygen, none required mechanical ventilation. The median hospital length of stay was 6 (range, 2-32) days and all patients were discharged alive. During follow-up, 6 (4 kidney, 2 heart; 6.5%) developed biopsy proven rejection. No graft loss or death occurred in this cohort.

*Conclusions: Early use of monoclonal antibodies in SOTr is associated with favorable outcomes. Multi-center studies assessing use of monoclonal antibodies in breakthrough infections and association with allograft rejection are needed.

To cite this abstract in AMA style:

Anjan S, Vu C, Vega A, Maxam M, Viotti JBini, Natori Y, Simkins J, Khatri A, Mattiazzi A, Vianna R, Cienki J, Lee L, Guerra G, Abbo L. Use of Monoclonal Antibodies for Treatment of Solid Organ Transplant Recipients with COVID-19: A Single Center Experience [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/use-of-monoclonal-antibodies-for-treatment-of-solid-organ-transplant-recipients-with-covid-19-a-single-center-experience/. Accessed November 21, 2024.

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