A Programmatic Response, Including Bamlanivimab or Casirivimab-imdevimab Administration, Reduces Hospitalization and Death in COVID-19 Positive Abdominal Transplant Recipients

Abstract

Background: Coronavirus-19 disease (COVID-19) has resulted in significant morbidity and mortality in solid organ transplant recipients. In December 2020, at the peak of the Los Angeles outbreak, our center rapidly implemented a protocol to improve outpatient management and provide Bamlanivimab or Casirivimab-Imdevimab (COVID mAb therapies) to all eligible COVID-19 positive liver and kidney transplant recipients. Methods: A retrospective review of all abdominal organ transplant recipients who were COVID-19 PCR+ between 2/2020-2/2021 from our center was performed. Patient demographics, COVID-19 treatments, hospitalizations, and survival were reviewed. Patients were considered eligible for COVID mAb therapy if they meet outpatient criteria at the time of diagnosis. Results: In the study period, 121 kidney transplant recipients (KG) and 105 liver or combined liver/kidney transplant recipients (LG) were COVID-19 PCR+. Hospitalization rates were similar for the KG (45%) versus LG (35%) (p=.20) but mortality was higher for the KG (22%) when compared to LG (10%) (p=.02). Our programmatic response, including outpatient COVID mAb therapies, reduced hospitalizations (p=.01) and deaths (p=.01). 94 KG and 87 LG patients were identified as potentially eligible for COVID mAb therapy and 17 KG and 17 LG patients were treated. COVID mAb therapies reduced hospitalization from 32% to 15% (p=.045) and eliminated mortality (13% vs 0%, p=.04). Conclusions: An aggressive approach including outpatient COVID mAb therapy in the COVID+ abdominal organ transplant recipients significantly decreased hospitalization and death. Early outpatient intervention for COVID-19 disease in transplant patients should be considered where possible.