Session Name: COVID-19
Session Date & Time: None. Available on demand.
*Purpose: Treatment options for patients with COVID 19 have limited efficacy in reducing severity and duration of viral symptoms as well as progression to severe disease. Bamlanivimab(LY-CoV555) received Emergency Use authorization (EUA) by the FDA on November 9,2020 for non-hospitalized COVID 19 patients with mild to moderate illness who are considered high risk for progression to severe COVID 19 or to require hospitalization such as those on chronic immunosuppression therapy post-transplant. In this study we review its use among patients with kidney transplant.
*Methods: 24 patients who tested positive for COVID 19 with nasopharyngeal PCR between November 9, 2020 and February 7, 2021 were retrospectively reviewed and analyzed. Labs, clinical course and communication with transplant team was reviewed. FDA approved standardized infusion dose was used.
*Results: Average age of recipients was 57.5 +/- 11.8 years. Hypertension was most common co-morbidity in 17/24 patients followed by Diabetes Mellitus in 10/24. 3 patients had combined Pancreas Transplant, 1 combined-heart and 1combined- Liver. 3/24(12.5%) patients required hospitalization, and supplemental oxygen, while 1 patient required mechanical ventilation and died. Dialysis therapy for acute kidney injury was required in 1 patient. Majority of patients 14/24 were on Tacrolimus and Mycophenolic acid. 13/24 had no change to their immunosuppression after COVID diagnosis while 7/24 had mycophenolic acid decreased to half or lower and in 4 cases it was held temporarily. 1 patient each reported headache, elevated blood pressure after infusion. Among the 3 patients who were hospitalized 1 patient each was diagnosed with Aspergillosis and Histoplasmosis. Results summarized in Table 1.Table 1. Characteristics and outcomes among patients receiving Bamlanivimab, n=24
|Age||57.5 +/- 11.8 Years|
|Gender||Male 58.3% Female 41.7%|
|Race:||Caucasian 83.3%, African American 12.5%, Hispanic 4.2%|
|Type of Transplant:||LDKT 41.7%, DDKT58.3%|
|Co-Morbidities:||Hypertension 75%, Diabetes Mellitus ( I and II) 41.7%%, Coronary Artery Disease 16.7%|
|Time from kidney transplant to COVID 19||2828 +/- 2893(mean) days, Median 1790 (19-11885) days|
|IS Regimen Pre COVID||tac/mpa 58.3% (n=14)||tac/mpa/prednisone 16.7% (n=4)||tac/sirolimus 8.3% (n=2)||cyc/mpa/Prednisone8.3% (n=2)|
|IS Regimen Post COVID||No change in IS 54.2% (n=13)||Decrease mpa by ½ or lower 29.2% (n=7)||Hold mpa 16.7% (n=4)|
|Time from COVID diagnosis to mab||2.25 (mean)+/-2.1 days||1 (median)(1-9)days|
|Hospitalizations||3||Supplemental Oxygen 3/3||ICU Admissions 2/3||Ventilator 1||Mortality 1|
|AKI||3||AKI requiring RRT||1|
|Dexamethasone||16.7% (n=4)||Remdesivir 8.3% (n=2)||Convalescent Plasma 1/24 4.2% (n=1)|
|Common Symptoms||Cough 29.2%||Fatigue 29.2%||Fever 20.8%||SOB20.8%||Headache 16.7%||Loss of taste/smell 12.5%||Asymptomatic 16.7%|
Living Donor Kidney Transplant, DDKT Deceased Donor Kidney Transplant, MPA mycophenolic acid, IS Immunosuppression, Tac. Tacrolimus, Cyc. Cyclosporin, RRT Renal Replacement Therapy, mab. monoclonal antibody
*Conclusions: To our knowledge this is the first report describing the use of Bamlanivimab in patients with Kidney Transplants. It showed a beneficial effect in immunosuppressed patients with mild to moderate COVID 19 symptoms with majority avoiding hospitalization. It appears to be well tolerated with no significant major adverse effects or allergic reactions in our cohort. Further large scale studies are needed to evaluate its impact on symptom duration and decrease in severity of COVID 19 among patients on immunosuppression for kidney transplant.
To cite this abstract in AMA style:Jan MY, El-Sayegh S, Yaqub MS, Mishler DP, Adebiyi O, Anderson MD, Taber TE, Sharfuddin A. Bamlanivimab for Covid-19 in Kidney Transplant Patients [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/bamlanivimab-for-covid-19-in-kidney-transplant-patients/. Accessed September 22, 2021.
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