Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California.
Division of Abdominal Transplantation, Department of Surgery, Stanford University School of Medicine, Stanford, California.
Kidney360. 2021 Oct 20;3(1):133-143. doi: 10.34067/KID.0005732021. eCollection 2022 Jan 27.
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.
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.
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.
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.
与 2019 年冠状病毒病（COVID-19）感染相关的发病率和死亡率在肾移植受者中较高，需要早期门诊干预以防止疾病进展为重症。2020 年 11 月，在美国，SARS-CoV-2 中和单克隆抗体，包括巴伦珠单抗和卡瑞利珠单抗/依德珠单抗，被授予紧急使用授权，用于治疗轻度至中度 COVID-19 疾病。
我们对 2020 年 7 月至 2021 年 2 月期间被诊断患有 COVID-19 并接受巴伦珠单抗或卡瑞利珠单抗/依德珠单抗和免疫抑制减少治疗的 27 例肾移植受者进行了回顾性分析。我们还确定了 13 例患有 COVID-19 的肾移植受者，这些患者在就诊时患有轻度至中度疾病，未接受 mAbs 治疗，且可进行 SARS-CoV-2 血清学检测。
两组均无死亡或移植物失败。两种输注均耐受良好。接受 mAbs 治疗的 27 例患者中有 4 例因 COVID-19 住院。未接受 mAbs 治疗的 13 例患者中有 4 例因 COVID-19 住院。接受 mAbs 治疗的患者在输注后 90 天内可检测到最高水平的抗 SARS-CoV-2 IgG 以及血管紧张素转换酶 2（ACE2）受体阻断活性，而 mAb 未治疗组获得的 ACE2 阻断活性较弱。
巴伦珠单抗和卡瑞利珠单抗/依德珠单抗联合免疫抑制减少治疗在肾移植受者中具有良好的耐受性，并与轻度至中度 COVID-19 诊断相关的良好临床结局相关。
