*Purpose: Bamlanivimab and casirivimab-imdevimab are authorized for emergency use treatment of mild-to-moderate COVID-19 in patients at high-risk for progression to severe disease or hospitalization. For various reasons, their use has been limited in the clinical setting. Moreover, their safety or efficacy has not been evaluated in solid organ transplant (SOT) recipients.

*Methods: The Mayo Monoclonal Antibody (MAB) Program was established on 11/07/2020. We retrospectively reviewed SOT recipients who received MAB for COVID-19 at Mayo Clinic in AZ, FL, or MN through 01/23/2021. Data included demographics, transplant type, and adverse effects attributed to MAB. Outcomes included emergency department (ED) visit, hospitalization, intensive care unit (ICU) admission, mortality, and allograft rejection at 28 days.

*Results: Seventy-three patients were treated. Median age was 59 years, 46 (63%) were male, and median Charlson comorbidity index was 5. Transplants included 41 kidney (56.2%), 13 liver (17.8%), 11 heart (15.1%), 4 kidney-pancreas (5.5%), 2 lung (2.7%), 1 heart-liver, and 1 pancreas recipient. Fifty-six patients had complete 28-day follow-up. Nine patients were hospitalized, including 7 attributed to COVID-19, for median of 4 days. No patient died, required mechanical ventilation, or had allograft rejection. Ten adverse effects were reported, most commonly fever, without any report of anaphylaxis. Median time to MAB from symptom onset was 6 days for hospitalized patients vs. 4 days among non-hospitalized patients (p=.03). Hospitalization was associated with hypertension (p=.02). Outcomes are presented in table 1.

*Conclusions: Hospitalizations and ED visits remain common after MAB for COVID-19 in SOT recipients. However, only one patient required ICU admission, and there was no death or rejection. Earlier MAB infusion appears to be more efficacious. Updated data from our expanding MAB Program will be presented at the ATC meeting.

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