Early Administration of Anti-SARS-CoV-2 Monoclonal Antibodies Prevents Severe COVID-19 in Kidney Transplant Patients

Abstract

Introduction: Kidney transplant recipients (KTRs) are prone to develop severe COVID-19 and are less well protected by vaccine than immunocompetent subjects. Thus, the use of neutralizing anti-SARS-CoV-2 monoclonal antibody (MoAb) to confer a passive immunity appears attractive in KTRs.

Methods: We performed a French nationwide study to compare COVID-19-related hospitalization, 30-day admission to intensive care unit (ICU), and 30-day death between KTRs who received an early infusion of MoAb (MoAb group) and KTRs who did not (control group). Controls were identified from the COVID-SFT registry (NCT04360707) using a propensity score matching with the following covariates: age, sex, delay between transplantation and infection, induction and maintenance immunosuppressive therapy, initial symptoms, and comorbidities.

Results: A total of 80 KTRs received MoAb between February 2021 and June 2021. They were matched to 155 controls. COVID-19-related hospitalization, 30-day admission to ICU, and 30-day death were less frequently observed in the MoAb group (35.0% vs. 49.7%, P = 0.032; 2.5% vs. 15.5%, P = 0.002; 1.25% vs. 11.6%, P = 0.005, respectively). No patient required mechanical ventilation in the MoAb group. The number of patients to treat to prevent 1 death was 9.7.

Conclusion: The early use of MoAb in KTRs with a mild form of COVID-19 largely improved outcomes in KTRs.

Keywords: COVID-19; monoclonal antibody; transplantation; viral infection.

Graphical abstract

Figure 1

Flowchart. KTR, kidney transplant recipient; MoAb, monoclonal antibody; rt-PCR, real-time polymerase chain reaction.

Figure 2

Use of anti–SARS-Cov-2 therapeutic antibodies between February 2021 and June 2021. The number of patients treated with bamlanivimab as monotherapy (n = 8), bamlanivimab-etesevimab (n = 39), or casirivimab-imdevimab (n = 33) is represented by month.

Figure 3

The 90-day patient survival in the patients treated with an early injection of anti–SARS-Cov-2 therapeutic antibody was greater than and matched than that of control recipients. Patients treated with therapeutic antibodies and control patients are presented by continuous and dotted line, respectively. The survival was higher in the patients treated with monoclonal antibodies (log-rank, P = 0.004). MoAb, monoclonal antibody.