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Published on: June 26, 2020
Coronavirus Disease 2019 (COVID-19) in Heart Transplant Recipients and Anti-SARS-CoV-2 Monoclonal Antibodies:
Rohan Kapur1, Kenji Okumura2, Suguru Ohira3
1From the Departments of Medicine.
Insights
Monoclonal antibodies (mAbs) effectively treat and prevent COVID-19 in heart transplant recipients. These treatments reduced hospitalizations and deaths, showing high safety and efficacy in this vulnerable population.
Area of Science:
- Immunology
- Infectious Diseases
- Cardiology
Background:
- Solid organ transplant recipients (SOTRs), including heart transplant (HT) patients, face increased risks from Coronavirus disease 2019 (COVID-19).
- Advances in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis and treatment have significantly lowered COVID-19 mortality in HT recipients from ~30% to <3% since early pandemic.
Purpose of the Study:
- To evaluate the safety and efficacy of anti-SARS-CoV-2 monoclonal antibodies (mAbs) for treating mild-to-moderate COVID-19 in adult HT recipients.
- To assess the effectiveness of tixagevimab/cilgavimab for pre-exposure prophylaxis against COVID-19 in HT recipients.
- To analyze outcomes including hospitalizations, mechanical ventilation, and death in HT recipients receiving mAbs.
Main Methods:
- Retrospective chart review of adult HT recipients at Westchester Medical Center (January 2020–December 2022) who received anti-SARS-CoV-2 mAbs.
- Literature review of SOTRs treated with mAbs for COVID-19.
- Analysis of treatment outcomes for patients receiving casirivimab/imdevimab, sotrovimab, or bebtelovimab for mild-to-moderate COVID-19.
- Assessment of pre-exposure prophylaxis with tixagevimab/cilgavimab in HT recipients.
Main Results:
- 42 HT recipients treated for mild-to-moderate COVID-19 with various mAbs showed no infusion-associated adverse effects, disease progression, hospitalizations, or deaths.
- 63 HT recipients received tixagevimab/cilgavimab for pre-exposure prophylaxis without immediate adverse events; 11 breakthrough infections were mild.
- Data suggest mAbs reduce hospitalization, ICU care needs, and mortality in HT recipients.
Conclusions:
- Anti-SARS-CoV-2 mAbs are safe and effective for treating and preventing COVID-19 in heart transplant recipients.
- Monoclonal antibody use in SOTRs is associated with reduced severe outcomes like hospitalization and death.
- Optimal administration of mAbs in SOTRs requires a programmatic team approach to ensure equitable access and minimize risks.
Abstract:
Solid organ transplant recipients (SOTRs), including heart transplant (HT) recipients, infected with Coronavirus disease 2019 (COVID-19) are at higher risk of hospitalization, mechanical ventilation, or death when compared with general population. Advances in diagnosis and treatment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have reduced COVID-19-related mortality rates from ~30% in the early pandemic to <3% in 2022 among HT recipients. We performed a retrospective chart review including adult HT recipients at Westchester Medical Center from January 1, 2020 to December 10, 2022, who received anti-SARS-CoV-2 monoclonal antibodies (mAbs) for treatment of mild-to-moderate COVID-19, and those who received tixagevimab/cilgavimab for preexposure prophylaxis. Additionally, a comprehensive review of the literature involving SOTRs who received mAbs for COVID-19 was conducted. In this largest single-center study in this population, 42 adult HT recipients received casirivimab/imdevimab (36%), sotrovimab (31%), or bebtelovimab (29%) for treatment of mild-to-moderate COVID-19. Among these recipients, no infusion-associated adverse effects, progression of disease, COVID-19-associated hospitalizations, or death were noted. Preexposure prophylaxis with tixagevimab/cilgavimab was given to 63 HT recipients in a dedicated infusion center (40%), inpatient setting (33%), or at time of annual heart biopsy (27%). No immediate adverse events were noted. There were 11 breakthrough infections, all mild. Overall, the data suggests that HT recipients receiving mAbs have reduced rates of hospitalization, need for intensive care unit care, or death. Use of anti-SARS-CoV-2 mAbs in SOTRs is resource intensive and requires a programmatic team approach for optimal administration and to minimize any risk of disparities in their use.
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