Kidney360 . SARS-CoV-2 Neutralizing Monoclonal Antibodies for the Treatment of COVID-19 in Kidney Transplant Recipients

[tetano]

Kidney360


. 2021 Oct 20;3(1):133-143.
doi: 10.34067/KID.0005732021. eCollection 2022 Jan 27.
SARS-CoV-2 Neutralizing Monoclonal Antibodies for the Treatment of COVID-19 in Kidney Transplant Recipients


Aileen X Wang ¹ , Stephan Busque ² , Jamie Kuo ³ , Upinder Singh ^{4 5} , Katharina Röeltgen ⁶ , Benjamin A Pinsky ^{4 6} , Glenn M Chertow ^{1 7} , John D Scandling ¹ , Colin R Lenihan ¹



Affiliations

• PMID: 35368573
• PMCID: PMC8967616
• DOI: 10.34067/KID.0005732021

Abstract

Background: Morbidity and mortality associated with coronavirus disease 2019 (COVID-19) infection in kidney transplant recipients are high and early outpatient interventions to prevent progression to severe disease are needed. SARS-CoV-2 neutralizing mAbs, including bamlanivimab and casirivimab-imdevimab, received emergency use authorization in the United States in November 2020 for treatment of mild to moderate COVID-19 disease.
Methods: We performed a retrospective analysis of 27 kidney transplant recipients diagnosed with COVID-19 between July 2020 and February 2021 who were treated with bamlanivimab or casirivimab-imdevimab and immunosuppression reduction. We additionally identified 13 kidney transplant recipients with COVID-19 who had mild to moderate disease at presentation, who did not receive mAbs, and had SARS-CoV-2 serology testing available.
Results: There were no deaths or graft failures in either group. Both infusions were well tolerated. Four of the 27 patients treated with mAbs required hospitalization due to COVID-19. Four of 13 patients who did not receive mAbs required hospitalization due to COVID-19. Patients who received mAbs demonstrated measurable anti-SARS-CoV-2 IgG with angiotensin-converting enzyme 2 (ACE2) receptor blocking activity at the highest level detectable at 90 days postinfusion, whereas ACE2 blocking activity acquired from natural immunity in the mAb-untreated group was weak.
Conclusions: Bamlanivimab and casirivimab-imdevimab combined with immunosuppression reduction were well tolerated and associated with favorable clinical outcomes in kidney transplant recipients diagnosed with mild to moderate COVID-19.

Keywords: COVID-19; SARS-CoV-2; immunosuppression; kidney transplant; monoclonal antibodies; transplantation.