Monoclonal Antibody Therapy for COVID-19 in Solid Organ Transplant Recipients

Zachary A Yetmar, Elena Beam, John C O'Horo, Ravindra Ganesh, Dennis M Bierle, Lisa Brumble, Maria Teresa Seville, Raymund R Razonable
2021 Open Forum Infectious Diseases  
Background Bamlanivimab and casirivimab-imdevimab are authorized for emergency use treatment of mild-to-moderate COVID-19 in patients at high-risk for developing severe disease or hospitalization. Their safety and efficacy have not been specifically evaluated in solid organ transplant recipients. Methods We retrospectively reviewed solid organ transplant recipients who received monoclonal antibody infusion for COVID-19 at Mayo Clinic sites through January 23, 2021. Outcomes included emergency
more » ... ncluded emergency department visit, hospitalization, mortality, and allograft rejection. Results Seventy-three patients were treated, most commonly with bamlanivimab (75.3%). Median age was 59 years, 63% were male, and the median Charlson comorbidity index was 5. Transplant type 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. Eleven (15.1%) patients had an emergency department visit within 28 days of infusion, including 9 (12.3%) who were hospitalized for a median of 4 days. One patient required intensive care unit admission for a non-respiratory complication. No patients required mechanical ventilation, died, or experienced rejection. Ten adverse events occurred with one seeking medical evaluation. Hypertension was associated with hospital admission (p<.05) while other baseline characteristics were similar. Median time from symptom onset to antibody administration was 4 days in non-hospitalized patients compared to 6 days among hospitalized patients (p<.05). Conclusions Monoclonal antibody treatment has favorable outcomes with minimal adverse effects in solid organ transplant recipients with mild-to-moderate COVID-19. Earlier administration of monoclonal antibody therapies appears to be more efficacious.
doi:10.1093/ofid/ofab255 pmid:34631921 pmcid:PMC8494079 fatcat:a56i5rmh7rcoxd6zq4gnsqr5fm