Monoclonal antibody treatment for COVID-19 in solid organ transplant recipients

Solid organ transplant (SOT) recipients are at high risk for severe coronavirus disease 2019 (COVID-19). Studies suggest that early intervention with monoclonal antibody (MAB) treatment directed against the SARS-CoV-2 spike protein may reduce the risk of emergency department visits or hospitalization for COVID-19, especially in high-risk patients. Herein we describe our single-center experience of 93 SOT (50 kidney, 17 liver, 11 lung, 9 heart and 6 dual-organ) recipients with mild to moderate COVID-19 who were treated with bamlanivimab or casirivimab-imdevimab per Emergency Use Authorization guidelines. Median age of recipients was 55 (IQR 44-63) years and 41% were diabetic. Median time from transplant to MAB was 64 (IQR 24-122) months and median time from onset of COVID-19 symptoms to the infusion was 6 (IQR 4-7) days. All patients had a minimum 30 days of study follow up. The 30-day hospitalization rate for COVID-19 directed therapy was 8.7%. Infusion-related adverse events were rare and generally mild. Biopsy-proven organ rejection occurred in 2 patients and there were no graft losses or deaths. A comparator group of 72 SOT recipients diagnosed with COVID-19 who were eligible but did not receive MAB treatment had a higher 30-day hospitalization rate for COVID-19 directed therapy (15.3%), although this difference was not statistically significant, after adjustment for age [OR 0.49 (95% CI 0.18-1.32), p = 0.16]. Our experience suggests that MAB treatment, with respect to the available MAB formulations and circulating viral variants present during our study period, may provide favorable outcomes for mild to moderate COVID-19 in SOT recipients. This article is protected by copyright. All rights reserved.