ABSTRACT
Purpose: Monoclonal antibody (mAB) infusion (bamlanivimab or casirivimab/ imdevimab) for symptomatic, non-hypoxemic, high-risk outpatients with COVID-19 infection, is an available early intervention for COVID-19+ SOT recipients. We aimed to assess efficiency in time from diagnosis to treatment, and outcomes in a retrospective cohort of SOT recipients with COVID-19 who received mAB. Methods: We developed a Nurse Coordinator-led initiative to screen, refer, and facilitate mAB infusion for COVID-19+ SOT recipients within 10 days of symptom onset. SOT recipients received electronic messaging to promptly report potential COVID-19 symptoms to the transplant team. Data were collected on time from symptom onset to diagnosis, mAB infusion, and follow-up > 21 days, and hospital admissions, disease severity, mortality, and rejection. Results: 34 out of 36 referred SOT recipients with symptomatic COVID-19 disease without hypoxia received mAB therapy (3 heart, 8 lung, 16 kidney, 2 Liver-Kidney, 2 Pancreas-Kidney, 3 Kidney-Heart). Median time from symptom onset to diagnosis was 2 days and from date of diagnosis to mAB infusion was 4 days. Of those 34, 88% did not require hospitalization and recovered uneventfully. 12% required hospitalization for COVID disease progression, two on the same day as mAB infusion, and the other 2, more than 26 days post infusion. Of these, 2 patients had mild-moderate hypoxia, and 2 had critical disease. Only 1 patient died from COVID-19 complications and no episodes of rejection or graft loss were observed. Conclusions: The Nurse Coordinator-led initiative efficiently facilitated mAB therapy for COVID-19+ SOT recipients and was associated with excellent outcomes. Compared to prior published COVID-19 outcomes in SOT recipients, patients who received mAB may have reduce hospitalization and low mortality. As mAB therapy may be underutilized in the general population, these results support efforts to educate transplant centers to implement efficient interventions for the screening and referral of COVID+ SOT recipients for mAB therapy.
ABSTRACT
Purpose: COVID-19 therapies have evolved over time, but little is known regarding outcomes in SOT recipients treated with newer therapeutic agents such as remdesivir, dexamethasone, and convalescent plasma. We sought to compare outcomes including mortality, rejection, and renal function in a retrospective cohort of SOT recipients with COVID-19 treated during two different eras of therapy. Methods: 40 SOT recipients hospitalized for COVID-19 at our center comprised Era 1 (Mar-May 2020, 20 patients) and Era 2 (Jun-Aug 2020, 20 patients). Data were collected on demographics, comorbidities, renal function, and mortality at time points out to 90 days after COVID-19 infection. Results: Patients in Era 1 received hydroxychloroquine (11/20, 55%), tocilizumab (5/20, 25%) and/or convalescent plasma (3/20, 15%) as targeted therapy;patients in Era 2 received primarily remdesivir (8/20, 40%), dexamethasone (6/20, 30%), and/or convalescent plasma (13/20, 65%). Mortality was 1/20 in Era 1 and 0/20 in Era 2. MMF was held in 33/35 (94%) of patients. Acute kidney injury was present on presentation in 14/40 (35%). The median (IQR) decrease in SCr (mg/dl) between admission and last followup was 0.5 (0.4-0.6) and 0.1 (0-0.4) in patients who had and had not received remdesivir, respectively (p=0.02), 0.5 (0.1-0.6) and 0.1 (0-0.3) in patients who had and had not received plasma, respectively (p=0.09). Antibodymediated rejection (AMR) occurred in 2 patients in Era 1 and 0 patients in Era 2. Acute cellular rejection (ACR) occurred in 1 patient in Era 1 and 0 patients in Era 2. Conclusions: SOT recipients treated in Era 2, when the major targeted therapies were remdesivir, dexamethasone, and convalescent plasma, were not at higher risk for renal dysfunction, ACR, or AMR in the aftermath of COVID-19;rejection was uncommon in both eras and mortality was low in both eras. While awaiting detailed safety studies, these results suggest against renal toxicity or triggering of alloimunity in those receiving newer therapies.