ABSTRACT
SARS-CoV-2 infection (COVID) is associated with high morbidity and mortality in solid organ transplants and vaccine efficacy is suboptimal. Tixagevimab and cilgavimab (T/C) are neutralizing antibodies used in the U.S. under emergency use authorization for COVID pre-exposure prophylaxis. However, T/C were developed when the Alpha and Omega variants were dominant. The purpose of this study is to look at real-world efficacy of T/C during the Omicron phase of the pandemic in heart transplants (HT). This was a retrospective study of adult HT recipients at a single center comparing those who received at least 3 doses of a COVID vaccine plus T/C versus those who only received the vaccine series (control) without prior infections. The primary outcome was development of COVID infection. Secondary outcomes included time from last vaccine to start of Omicron phase of pandemic, time from last vaccine to infection, and time from HT to infection. The Omicron phase was defined from 1/2022 to 2/2022. Chi-square and t-tests were used to assess for differences. Of the 244 patients identified, 44 received vaccination + T/C and 200 had vaccines only (Table 1). In the T/C group, patients were younger and more female (Table 1). In the control and T/C groups, 23% and 9.1% of patients, respectively, had documented COVID infections during the Omicron phase (p=0.039, Table 2). Months from last vaccine to start of Omicron phase, months from last vaccine to infection, and time from date of transplant to infection were similar between the two groups. Characteristics of the T/C patients who had breakthrough infections are shown in Table 3, none of whom required hospitalization or died. Patients who received vaccination + T/C had a significantly lower incidence of COVID infection compared to those who received vaccination alone in the Omicron era. T/C appeared to be protective in both recent and remote HT recipients, underscoring the utility of administering protective monoclonal antibodies in this population. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Purpose: Evaluate the impact of the COVID-19 pandemic on the transplant pharmacist workforce. Methods: A voluntary survey open from August 18, 2020 to September 15, 2020 was sent out to two prominent solid organ transplant pharmacy listservs. Respondents were asked to give background about their transplant institution, patient population and departmental staffing. Respondents were asked to comment on how the COVID-19 pandemic has impacted their ability to perform their transplant related activities for patient care. Results: A total of 67 transplant pharmacists from 57 centers responded to the survey. The majority (61.2%) of pharmacists surveyed practice primarily in abdominal transplant programs with 29.8% at small, 33.3% at moderate, and 36.8% at large volume centers (<100, 100-300, and >300 total transplants, respectively). Almost all institutions have a living donor kidney transplant program (96.5%) and in response to the COVID-19 pandemic, 55.2% of centers reported stopping non-life saving kidney and liver transplants, most (89.6%) stopped living donor transplants. A majority (73.1%) of pharmacists surveyed were funded by the pharmacy cost center. Due to the pandemic, 40% of centers surveyed stopped performing bedside medication education, and 46.3% no longer allowed caregivers on site for medication education (Figure 1). Consequently, 41.8% of the pharmacists surveyed felt that their confidence in their patients' understanding of medications decreased. Transplant pharmacists reported a perceived mean decrease in resources required for daily work responsibilities of 0.18% (IQR-0.35-0), 0.11% (IQR-0.3-0), and 0.26% (IQR-0.43-0) at low, moderate, and high volume transplant centers, respectively;however, there was no statistical difference. The perceived mean decrease in resources for pharmacists who are under the pharmacy cost center (0.18%, IQR-0.35-0) compared to those who are not (0.12%, IQR-0.3-0) was also not significantly different. Conclusions: There was a reported reduction in transplant pharmacist services due to the COVID-19 pandemic, particularly with patient education, and a perceived reduction in available resources, but no difference based on center volume. While life-saving transplant continued, the impact of patient education on outcomes remains uncertain.