Clinical Outcomes of Lung Transplant Recipients with Covid-19 That Received Pre-Exposure Prophylaxis with Tixagevimab-Cilgavimab: A Single Center Experience

ABSTRACT

Lung transplant recipients (LTRs) are at risk of significant morbidity and mortality due to COVID-19. The neutralizing antibody response to vaccination among LTRs is reduced, particularly in those treated with anti-proliferative agents. Tixagevimab-cilgavimab (Tix-Cil) is a SARS-CoV-2 spike protein-directed attachment inhibitor that is authorized under Emergency Use Authorization (EUA) to reduce the risk of COVID-19 in immunocompromised adults. We describe the clinical outcomes of LTRs who contracted COVID-19 despite Tix-Cil therapy. After IRB approval, we conducted a retrospective chart review and used descriptive statistics. Following EUA approval, 203 LTRs received Tix-Cil, and 24 (11.8%) subsequently contracted COVID-19. All 24 had undergone bilateral LT;14 (58.3%) were male;23 (95.8%) were vaccinated;and 23 (95.8%) were ≥6 months out from LT. The median age at COVID-19 diagnosis was 68.6 years, and most (75%) were on a standard 3-drug immunosuppressive regimen with tacrolimus, mycophenolate mofetil, and prednisone. The median time from Tix-Cil to COVID-19 diagnosis was 90.5 days (62.75-118.25). Five LTRs (20.8%) were hospitalized;3 (12.5%) required ICU level of care;and 2 (8.3%) were intubated. Two LTRs (8.3%) died;both were male, >70 years old, vaccinated, >2 years out from LT, and had co-morbidities. Both were treated with corticosteroids and tocilizumab;1 received anti-viral and monoclonal antibody therapy with remdesevir and sotrovimab, respectively. Both were critically ill, and 1 was intubated. LTRs that contracted COVID-19 despite pre-exposure prophylaxis with Tix-Cil had significant rates of hospitalization, critical illness, and mortality. More effective therapies are needed to reduce the risk of COVID-19 in this vulnerable patient population. [ABSTRACT 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 abstract 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 abstract. (Copyright applies to all Abstracts.)