Improved Mortality in COVID-19 Kidney Transplant Recipients Treated with Bamlanivimab

ABSTRACT

Purpose: Transplant recipients are particularly vulnerable to catastrophic sequelae of COVID-19. In an early multi-center study of 482 solid organ transplant (SOT) recipients with COVID-19, the authors reported a large percentage of hospitalizations (78%), mechanical ventilation (31%), and death (20.5%) during a 28 day window. Despite mortality reduction following the vaccine, COVID remains a mortality risk in this population. We sought to identify interventions to further mitigate the mortality risk. Bamlanivimab is a recombinant neutralizing human IgG1 monoclonal antibody (mAb) directed against the spike protein of SARS-Cov-2. We evaluated patient outcomes when early disease diagnosis was paired with mAb bamlanivimab therapy. Method(s) In a single center cohort of 147 kidney transplant recipients who tested positive for COVID during a 12 month period from March 2020 to March 2021, 41 eligible patients received IV bamlanivimab therapy. Eligible patients had symptoms <7 days and did not require supplemental oxygen at the time of bamlanivimab therapy. Patients in the exclusion group also included patients diagnosed with COVID before bamlanivimab was available. Result(s) Of 41 patients who received IV bamlanivimab therapy, zero deaths were observed and only four hospitalizations. Two patients required ventilatory support but were eventually successfully extubated. In contrast, of the 106 patients who did not receive bamlanivimab the mortality rate was 15 deaths (14%).In the total cohort of 147 kidney transplant patients, 68 patients required hospitalization (47%). Of these 68 patients, 21 patients were intubated (14%) and all 15 mortalities occurred in patients ineligible for bamlanivimab. Conclusion(s) Early detection of COVID-19 within 7 days of symptoms allowing for early intervention with mAb bamlanivimab therapy significantly reduced disease severity and mortality risk amongst kidney transplant recipients.