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. 2024 Dec 4;8(12):e70072.
doi: 10.1002/jgh3.70072. eCollection 2024 Dec.

Impact of Immunosuppressive Therapy, Vaccination, and Monoclonal Antibody Use With Outcomes in Liver and Kidney Transplant Recipients With COVID-19: A Retrospective Study

Ashley Francis  1 , Ammad Javaid Chaudhary  2 , Abdullah Sohail  3 , Zahid I Tarar  4 , Ali Jaan  5 , Joseph P Cavataio  1 , Sara Farooqui  1 , Adarsh Varma  6 , Syed-Mohammed Jafri  6
Affiliations

Impact of Immunosuppressive Therapy, Vaccination, and Monoclonal Antibody Use With Outcomes in Liver and Kidney Transplant Recipients With COVID-19: A Retrospective Study

Ashley Francis et al. JGH Open. .

Abstract

Background and aim: Patients who have undergone solid organ transplantation are at an elevated risk of severe coronavirus disease (COVID-19) because of post-transplantation immunosuppressive therapy. However, optimization of vaccination, modification of immunosuppression, and implementation of monoclonal antibody (mAb) therapy in transplant recipients with COVID-19 is uncertain.

Methods: A retrospective cross-sectional study was conducted on patients who underwent liver or kidney transplants and were diagnosed with COVID-19. The association of several vaccine doses, mycophenolate therapy, and mAB therapy with mortality outcomes after COVID-19 diagnosis (3 and 6 months), hospitalization, and length of hospital stay were assessed.

Results: This study included 255 patients with a median age of 59 (23-89) were included. Many COVID-19 vaccine doses were not associated with any outcome; however, patients with a liver transplanted with mycophenolate had higher 3-month (19% vs. 0%; p = 0.02) and 6-month (21% vs. 0%; p = 0.01) mortality rates than those who did not. In addition, transplant recipients who received mAb therapy for COVID-19 were less likely to be hospitalized (37% vs. 68%; p < 0.001).

Conclusions: For organ transplant recipients with COVID-19, vaccination alone may not be an optimal strategy for preventing serious outcomes. Rather, the types of organ transplant, immunosuppressive therapy (particularly mycophenolate), and COVID-19 treatment strategy should be synergistically considered to promote an optimal therapeutic dynamic for a vulnerable population.

Keywords: COVID‐19; immunosuppression; monoclonal antibodies; solid organ transplantation; vaccination.

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Conflict of interest statement

The authors declare no conflicts of interest.

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