tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2021 Jun 7;8(6)
fab255.
doi: 10.1093/ofid/ofab255. eCollection 2021 Jun.
Monoclonal Antibody Therapy for COVID-19 in Solid Organ Transplant Recipients
Zachary A Yetmar[SUP] 1 [/SUP], Elena Beam[SUP] 1 [/SUP], John C O'Horo[SUP] 1 2 [/SUP], Ravindra Ganesh[SUP] 3 [/SUP], Dennis M Bierle[SUP] 3 [/SUP], Lisa Brumble[SUP] 4 [/SUP], Maria Teresa Seville[SUP] 5 [/SUP], Raymund R Razonable[SUP] 1 [/SUP]
Affiliations
Abstract
Background: Bamlanivimab and casirivimab-imdevimab are authorized for emergency use treatment of mild to moderate coronavirus disease 2019 (COVID-19) in patients at high risk for developing severe disease or hospitalization. Their safety and efficacy have not been specifically evaluated in solid organ transplant recipients.
Methods: We retrospectively reviewed solid organ transplant recipients who received monoclonal antibody infusion for COVID-19 at Mayo Clinic sites through January 23, 2021. Outcomes included emergency department visit, hospitalization, mortality, and allograft rejection.
Results: Seventy-three patients were treated, most commonly with bamlanivimab (75.3%). The median age was 59 years, 63% were male, and the median Charlson comorbidity index was 5. Transplant type included 41 kidney (56.2%), 13 liver (17.8%), 11 heart (15.1%), 4 kidney-pancreas (5.5%), 2 lung (2.7%), 1 heart-liver, and 1 pancreas. Eleven (15.1%) patients had an emergency department visit within 28 days of infusion, including 9 (12.3%) who were hospitalized for a median of 4 days. One patient required intensive care unit admission for a nonrespiratory complication. No patients required mechanical ventilation, died, or experienced rejection. Ten adverse events occurred, with 1 seeking medical evaluation. Hypertension was associated with hospital admission (P < .05), while other baseline characteristics were similar. The median time from symptom onset to antibody administration was 4 days in nonhospitalized patients compared with 6 days among hospitalized patients (P < .05).
Conclusions: Monoclonal antibody treatment has favorable outcomes with minimal adverse effects in solid organ transplant recipients with mild to moderate COVID-19. Earlier administration of monoclonal antibody therapy appears to be more efficacious.
Keywords: COVID-19; SARS-CoV-2; bamlanivimab; casirivimab-imdevimab; transplant.
. 2021 Jun 7;8(6)
fab255.doi: 10.1093/ofid/ofab255. eCollection 2021 Jun.
Monoclonal Antibody Therapy for COVID-19 in Solid Organ Transplant Recipients
Zachary A Yetmar[SUP] 1 [/SUP], Elena Beam[SUP] 1 [/SUP], John C O'Horo[SUP] 1 2 [/SUP], Ravindra Ganesh[SUP] 3 [/SUP], Dennis M Bierle[SUP] 3 [/SUP], Lisa Brumble[SUP] 4 [/SUP], Maria Teresa Seville[SUP] 5 [/SUP], Raymund R Razonable[SUP] 1 [/SUP]
Affiliations
- PMID: 34631921
- PMCID: PMC8494079
- DOI: 10.1093/ofid/ofab255
Abstract
Background: Bamlanivimab and casirivimab-imdevimab are authorized for emergency use treatment of mild to moderate coronavirus disease 2019 (COVID-19) in patients at high risk for developing severe disease or hospitalization. Their safety and efficacy have not been specifically evaluated in solid organ transplant recipients.
Methods: We retrospectively reviewed solid organ transplant recipients who received monoclonal antibody infusion for COVID-19 at Mayo Clinic sites through January 23, 2021. Outcomes included emergency department visit, hospitalization, mortality, and allograft rejection.
Results: Seventy-three patients were treated, most commonly with bamlanivimab (75.3%). The median age was 59 years, 63% were male, and the median Charlson comorbidity index was 5. Transplant type included 41 kidney (56.2%), 13 liver (17.8%), 11 heart (15.1%), 4 kidney-pancreas (5.5%), 2 lung (2.7%), 1 heart-liver, and 1 pancreas. Eleven (15.1%) patients had an emergency department visit within 28 days of infusion, including 9 (12.3%) who were hospitalized for a median of 4 days. One patient required intensive care unit admission for a nonrespiratory complication. No patients required mechanical ventilation, died, or experienced rejection. Ten adverse events occurred, with 1 seeking medical evaluation. Hypertension was associated with hospital admission (P < .05), while other baseline characteristics were similar. The median time from symptom onset to antibody administration was 4 days in nonhospitalized patients compared with 6 days among hospitalized patients (P < .05).
Conclusions: Monoclonal antibody treatment has favorable outcomes with minimal adverse effects in solid organ transplant recipients with mild to moderate COVID-19. Earlier administration of monoclonal antibody therapy appears to be more efficacious.
Keywords: COVID-19; SARS-CoV-2; bamlanivimab; casirivimab-imdevimab; transplant.