Outcomes of Kidney Transplant Recipients with Covid-19 in Singapore Treated with Sotrovimab in the Era of the Delta Variant
1National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore, 2Medicine, National University Hospital, Singapore, Singapore, 3Infectious Diseases, National University Hospital, Singapore, Singapore
Meeting: 2022 American Transplant Congress
Abstract number: 696
Keywords: COVID-19, Kidney transplantation
Topic: Clinical Science » Infection Disease » 24 - All Infections (Excluding Kidney & Viral Hepatitis)
Session Information
Session Name: All Infections (Excluding Kidney & Viral Hepatitis) I
Session Type: Poster Abstract
Date: Saturday, June 4, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 5:30pm-7:00pm
Location: Hynes Halls C & D
*Purpose: Kidney transplant recipients (KTRs) are at higher risk for severe COVID-19 caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Sotrovimab decreases the risk of disease progression in the general population, but efficacy and safety in KTRs is unknown. Herein, we describe our experience in treating COVID-19 infected KTRs with sotrovimab.
*Methods: We performed a retrospective, single-center cohort study of KTRs diagnosed with COVID-19 by polymerase chain reaction from 07/15/21-11/30/21. KTRs with COVID-19 were admitted to the hospital to expedite evaluation and treatment. KTRs with COVID-19 were eligible for sotrovimab if they 1) were not requiring oxygen at admission, 2) were unvaccinated or if SARS-CoV-2 spike antibody (SAb) after vaccination was <100 U/mL, and 3) duration of symptoms/day of illness (DOI) was ≤7 days. COVID-19 disease requiring oxygen therapy was treated with remdesevir + dexamethasone. Immunomodulator therapy (baricitinib or tocilizimab) was given for rapidly progressive disease requiring high-flow oxygen or ICU care. Baseline characteristics, treatments, and outcomes including oxygen supplementation, ICU admission, and mortality were manually abstracted and evaluated.
*Results: In all, 36 KTRs were diagnosed with COVID-19 – mean age 59 years, 72% male, 67% Chinese, 64% diabetic and 17% obese; 72% were deceased donor and 28% were living donor KTRs presenting a mean 11 years from transplant. The majority (69%) were vaccinated with ≥2 doses of mRNA-based SARS-CoV-2 vaccines, 22% received 3 doses, and 15% were unvaccinated. Among KTRs who received ≥2 doses, SAb was reactive in 36% and >100 U/mL in 16%. In all, 14 (39%) required oxygen, 11 (31%) required ICU admission, 5 (14%) were mechanically ventilated, and 4 (11%) died (Table). Sotrovimab was given to 27 eligible KTRs at median DOI 2 (range 0-6). Of these, 8 (30%) required oxygen, 5 (19%) required ICU admission, 2 (7%) were mechanically ventilated, and 1 died (4%). KTRs receiving sotrovimab at DOI ≤3 vs >3 were less likely to require oxygen (p=0.01) or ICU admission (p=0.02). Sotrovimab was well tolerated with one associated adverse event (self-limiting diarrhea).
*Conclusions: KTRs remain at high risk for severe COVID-19. Sotrovimab administered early in the disease course is associated with a lower rate of severe COVID-19.
| Outcomes N(%) | Overall (N=36KTRs) | Sotrovimab administered day 1-3 of illness (N=20) | Sotrovimiab administered day 4+ of illness (N=7) |
| Any oxygen supplementation | 14 (39%) | 3 (15%) | 5 (71%) |
| ICU admission | 11 (31%) | 2 (10%) | 3 (43%) |
| Mortality, any cause | 4 (11%) | 0 | 1 (14%) |
To cite this abstract in AMA style:
D'Costa MR, Sran HK, Wong E, Chang Z, Chua Y, Somani J, Lum L, Vathsala A. Outcomes of Kidney Transplant Recipients with Covid-19 in Singapore Treated with Sotrovimab in the Era of the Delta Variant [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-kidney-transplant-recipients-with-covid-19-in-singapore-treated-with-sotrovimab-in-the-era-of-the-delta-variant/. Accessed May 9, 2025.« Back to 2022 American Transplant Congress