*Purpose: Kidney transplant recipients are at high-risk for severe coronavirus disease 2019 (COVID-19). Studies suggest that intervention with monoclonal antibody (MAB) treatment may decrease hospitalization rates. Here we describe a single-center experience of the use of casirivimab-imdevimab, a currently approved MAB, for treatment of COVID-19 disease in kidney transplant recipients.

*Methods: This is a retrospective single center study of adult kidney transplant patients who were diagnosed with mild to moderate COVID-19 and received casirivimab-imdevimab as an outpatient infusion between 12/29/20 to 10/20/21. All patients had at least 30 days of study follow-up from date of infusion.

*Results: 69 patients were included with the following characteristics: 65.2% male, 73.9% white, mean age 50±13 years, 33% diabetic. Median time from transplant to COVID-19 diagnosis was 80 (IQR 33-143) months. 49.3% of patients were not vaccinated for COVID-19 while 1.5%, 34.8%, and 14.5% had received 1, 2 and 3 doses, respectively. Median time from COVID-19 diagnosis to MAB treatment was 3 (range 0-9) days. Of the 69 patients, 3 (4.3%) required hospitalization within 30 days after MAB infusion (table). There were no emergency department-only visits within 30 days after MAB infusion. There were no deaths, graft losses, or acute rejection episodes recorded in the 30-day follow-up period. One infusion reaction of flushing and palpitations was reported.

*Conclusions: To our knowledge, this study describes the largest cohort of kidney transplant recipients treated with casirivimab-imdevimab and demonstrates that among high-risk, immunosuppressed patients with COVID-19, casirivimab-imdevimab therapy is associated with low rates of hospitalization and a favorable safety profile.

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