ABSTRACT
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. Method(s): 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. Result(s): 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. Conclusion(s): 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, casirivimabimdevimab therapy is associated with low rates of hospitalization and a favorable safety profile.
ABSTRACT
Purpose: The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or COVID-19, has emerged as a viral pandemic and brought unprecedented challenges worldwide on health care systems, including our transplantation community. Data on the clinical characteristics and outcomes of patients with COVID-19 infection in kidney transplant recipients (KTRs) remain uncertain. Here we describe the clinical characteristics and outcomes of KTRs in the Southeastern US who contracted COVID-19. Methods: A retrospective review of KTRs who tested positive for COVID-19 from March 15th, 2020 until November 25th, 2020 and followed at our institution were included. Data including patient demographics, history, laboratory results, radiological findings, and clinical outcomes was collected from the electronic medical record. Summary statistics using Kruskal-Wallis and Chi-square tests were performed. Multivariable logistic regression was used to identify risk factors for inpatient admission. Results: There were 104 patients who tested positive for COVID-19 either at our institution or a referring hospital (Table 1). Fifty-six (54%) patients required hospitalization. Labs on admission were: mean WBC 6.6±2.8 (x10-3/mcL), serum creatinine 2.3±1.7 (mg/dL), CRP 96±84 (mg/L), ferritin 1093±1052 (ng/mL), procalcitonin 0.62±1.0 (ng/mL), lactate 1.2±0.4 (mEq/L). Admitted patients were treated with dexamethasone (54%) and remdesivir (23%), and the anti-metabolite was held in 71%. Nineteen patients required ICU stay, 13 were intubated, 25 developed AKI and 12 died related to COVID-19 (11%). Mean length of inpatient stay was 11±13 days. After adjustment for age, DM and CAD status, the risk of admission due to COVID-19 was higher in those presenting with fever (OR 3.12, 95% CI 1.23-7.92, P-Value 0.017), and SOB (OR 7.64,95% CI 1.89-30.9, P-Value 0.004) (Table 2). Conclusions: The majority of KTRs with COVID-19 in our cohort required hospital admission. The mortality rate was 11% which is at the lower end of the spectrum of what has been previously reported. Despite this, COVID-19 remains a significant risk for our kidney transplant recipients with a high rate of hospital admission.