Fernandes Guillaume, Devresse Arnaud, Scohy Anais, De Greef Julien, Yombi Jean Cyr, Belkhir Leila, Darius Tom, Mourad Michel, Buemi Antoine, Kabamba Benoit, Goffin Eric, Kanaan Nada
Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Microbiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Kidney Med. 2022 Jun;4(6):100470. doi: 10.1016/j.xkme.2022.100470. Epub 2022 Apr 27.
RATIONALE & OBJECTIVE: Neutralizing monoclonal antibody treatments have shown promising preliminary results in kidney transplant recipients infected with severe acute respiratory syndrome coronavirus 2. However, their efficacy in kidney transplant recipients infected with the Omicron variant has not been reported yet.
Single-center retrospective study.
SETTING & PARTICIPANTS: We included all consecutive kidney transplant recipients treated with monoclonal antibodies for severe acute respiratory syndrome coronavirus 2 infections (positive polymerase chain reaction on nasopharyngeal swab) between June 10, 2021, and January 14, 2022. Forty-seven kidney transplant recipients were included. All patients had symptoms evolving for ≤7 days and no oxygen therapy need at monoclonal antibody infusion.
Symptoms at diagnosis were mainly cough (n = 25; 53%) and fever (n = 15; 32%). Eighty-three percent of the cohort (n = 39) had been vaccinated with at least 2 doses before infection, of whom 30 (77%) had demonstrated a vaccine-induced humoral response. They were treated with either casirivimab-imdevimab (n = 16; 34%) or sotrovimab (n = 31; 66%) a median of 2 days (range, 0-6 days) after the onset of symptoms. Except for 1 mild allergic reaction during casirivimab-imdevimab infusion, no side effects were reported. The median viral loads at admission (day 0) and 7 days after monoclonal antibody infusion were 2,110,027 copies/mL (range, 1,000-153,798,962 copies/mL) and 1,000 copies/mL (range, 0-10,000,000 copies/mL), respectively. Genotypes were available for 22 kidney transplant recipients (47%). Omicron, Delta, and Gamma variants were identified in 13 (59%), 8 (36%), and 1 (5%) patients, respectively. In kidney transplant recipients infected with the Omicron variant, the median viral loads at day 0 and day 7 were 752,789 copies/mL (range, 4,000-12,859,300 copies/mL) and 1,353 copies/mL (range, 0-1,211,163 copies/mL), respectively. 2 kidney transplant recipients required hospitalization immediately after sotrovimab perfusion for oxygen therapy that was weaned in 3 days, allowing patients' discharge. None were admitted to the intensive care unit or died.
Small sample size, no control group.
Neutralizing monoclonal antibody therapy is associated with positive outcomes in kidney transplant recipients with mild coronavirus disease 2019, including those infected with the Omicron variant.
中和单克隆抗体治疗在感染严重急性呼吸综合征冠状病毒2的肾移植受者中已显示出有前景的初步结果。然而，其在感染奥密克戎变种的肾移植受者中的疗效尚未见报道。
单中心回顾性研究。
我们纳入了2021年6月10日至2022年1月14日期间所有因严重急性呼吸综合征冠状病毒2感染（鼻咽拭子聚合酶链反应呈阳性）而接受单克隆抗体治疗的连续性肾移植受者。共纳入47例肾移植受者。所有患者症状出现时间≤7天，在输注单克隆抗体时无需吸氧治疗。
诊断时的症状主要为咳嗽（n = 25；53%）和发热（n = 15；32%）。该队列中83%（n = 39）的患者在感染前已接种至少2剂疫苗，其中30例（77%）表现出疫苗诱导的体液反应。他们在症状出现后中位数2天（范围0 - 6天）接受了卡西瑞维单抗 - 英迪维单抗（n = 16；34%）或索托维单抗（n = 31；66%）治疗。除了卡西瑞维单抗 - 英迪维单抗输注期间出现1例轻度过敏反应外，未报告其他副作用。入院时（第0天）和单克隆抗体输注后7天的病毒载量中位数分别为2,110,027拷贝/毫升（范围1,000 - 153,798,962拷贝/毫升）和1,000拷贝/毫升（范围0 - 10,000,000拷贝/毫升）。22例肾移植受者（47%）的基因型可获得。分别在13例（59%）、8例（36%）和1例（5%）患者中鉴定出奥密克戎、德尔塔和伽马变种。在感染奥密克戎变种的肾移植受者中day 0和day 7的病毒载量中位数分别为752,789拷贝/毫升（范围4,000 - 12,859, 300拷贝/毫升）和1,353拷贝/毫升（范围 0 - 1,211,163拷贝/毫升）。2例肾移植受者在索托维单抗灌注后立即因吸氧治疗而住院，3天内撤机，患者出院。无人入住重症监护病房或死亡。
样本量小，无对照组。
中和单克隆抗体治疗对于患有轻度2019冠状病毒病的肾移植受者，包括那些感染奥密克戎变种的患者，具有积极的治疗效果。
