COVID-19 and Solid Organ Transplantation: Role of Anti-SARS-CoV-2 Monoclonal Antibodies

Overview

Journal Curr Transplant Rep

Date 2022 Jan 24

PMID 35070639

Authors

Abhay Dhand

Raymund R Razonable

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: Solid organ transplant recipients (SOTRs) are ideal candidates for early treatment or prevention of coronavirus disease 2019 (COVID-19) using anti-SARS-CoV-2 monoclonal antibodies because of multiple underlying medical conditions, chronic immune-suppression, sub-optimal immunogenic response to vaccination, and evolving epidemiological risks. In this article, we review pertinent challenges regarding the management of COVID-19 in SOTRs, describe the role of active and passive immunity in the treatment and prevention of COVID-19, and review real-world data regarding the use of anti-SARS-CoV-2 monoclonal antibodies in SOTRs.

Recent Findings: The use of an anti-SARS-CoV-2 monoclonal antibody in high-risk solid organ transplant recipients is associated with a reduction in the risk of hospitalization, need for intensive care, and death related to COVID-19. Overall, the early experiences from a diverse population of solid organ transplant recipients who were treated with anti-spike monoclonal antibodies are encouraging with no reported acute graft injury, severe adverse events, or deaths related to COVID-19.

Summary: Anti-SARS-CoV-2 antibodies are currently authorized for treatment of mild-moderate COVID-19 and post-exposure prophylaxis, including in SOTRs. Potential future uses include pre-exposure prophylaxis in certain high-risk persons and synergistic use along with emerging oral treatment options. Successful timely administration of anti-SARS-CoV-2 monoclonal antibodies requires a multidisciplinary team approach, effective communication between patients and providers, awareness of circulating viral variants, acknowledgement of various biases affecting treatment, and close monitoring for efficacy and tolerability.

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References

Razonable R, Aloia N, Anderson R, Anil G, Arndt L, Arndt R . A Framework for Outpatient Infusion of Antispike Monoclonal Antibodies to High-Risk Patients with Mild-to-Moderate Coronavirus Disease-19: The Mayo Clinic Model. Mayo Clin Proc. 2021; 96(5):1250-1261. PMC: 7942148. DOI: 10.1016/j.mayocp.2021.03.010. View

Dhand A, Lobo S, Wolfe K, Feola N, Nabors C . Bamlanivimab for treatment of COVID-19 in solid organ transplant recipients: Early single-center experience. Clin Transplant. 2021; 35(4):e14245. PMC: 7995073. DOI: 10.1111/ctr.14245. View

Rabinowich L, Shibolet O, Katchman H . Reply to: "Effectiveness of SARS-CoV-2 vaccination in liver transplanted patients: The debate is open!". J Hepatol. 2021; 76(1):239-240. PMC: 8498774. DOI: 10.1016/j.jhep.2021.09.037. View

Hall V, Ferreira V, Ku T, Ierullo M, Majchrzak-Kita B, Chaparro C . Randomized Trial of a Third Dose of mRNA-1273 Vaccine in Transplant Recipients. N Engl J Med. 2021; 385(13):1244-1246. PMC: 8385563. DOI: 10.1056/NEJMc2111462. View

Jiang S, Hillyer C, Du L . Neutralizing Antibodies against SARS-CoV-2 and Other Human Coronaviruses. Trends Immunol. 2020; 41(5):355-359. PMC: 7129017. DOI: 10.1016/j.it.2020.03.007. View

Aslam S, Danziger-Isakov L, Mehra M . COVID-19 vaccination immune paresis in heart and lung transplantation. J Heart Lung Transplant. 2021; 40(8):763-766. PMC: 8116313. DOI: 10.1016/j.healun.2021.04.018. View

Buchwald U, Pirofski L . Immune therapy for infectious diseases at the dawn of the 21st century: the past, present and future role of antibody therapy, therapeutic vaccination and biological response modifiers. Curr Pharm Des. 2003; 9(12):945-68. DOI: 10.2174/1381612033455189. View

Qin C, Moore L, Anjan S, Rahamimov R, Sifri C, Ali N . Risk of Breakthrough SARS-CoV-2 Infections in Adult Transplant Recipients. Transplantation. 2021; 105(11):e265-e266. PMC: 8549120. DOI: 10.1097/TP.0000000000003907. View

Del Bello A, Marion O, Vellas C, Faguer S, Izopet J, Kamar N . Anti-SARS-CoV-2 Monoclonal Antibodies in Solid-organ Transplant Patients. Transplantation. 2021; 105(10):e146-e147. PMC: 8487703. DOI: 10.1097/TP.0000000000003883. View

10.

Hadi Y, Naqvi S, Kupec J, Sofka S, Sarwari A . Outcomes of COVID-19 in Solid Organ Transplant Recipients: A Propensity-matched Analysis of a Large Research Network. Transplantation. 2021; 105(6):1365-1371. PMC: 8414593. DOI: 10.1097/TP.0000000000003670. View

11.

Dhand A, Lobo S, Wolfe K, Feola N, Lee L, Nog R . Casirivimab-imdevimab for Treatment of COVID-19 in Solid Organ Transplant Recipients: An Early Experience. Transplantation. 2021; 105(7):e68-e69. DOI: 10.1097/TP.0000000000003737. View

12.

Casadevall A, Dadachova E, Pirofski L . Passive antibody therapy for infectious diseases. Nat Rev Microbiol. 2004; 2(9):695-703. DOI: 10.1038/nrmicro974. View

13.

Zhang J, Chen J, Liu Y, Zhang Z, Gao H, Liu Y . A serological survey on neutralizing antibody titer of SARS convalescent sera. J Med Virol. 2005; 77(2):147-50. PMC: 7167078. DOI: 10.1002/jmv.20431. View

14.

Vinson A, Agarwal G, Dai R, Anzalone A, Lee S, French E . COVID-19 in Solid Organ Transplantation: Results of the National COVID Cohort Collaborative. Transplant Direct. 2021; 7(11):e775. PMC: 8500600. DOI: 10.1097/TXD.0000000000001234. View

15.

Bierle D, Ganesh R, Wilker C, Hanson S, Moehnke D, Jackson T . Influence of Social and Cultural Factors on the Decision to Consent for Monoclonal Antibody Treatment among High-Risk Patients with Mild-Moderate COVID-19. J Prim Care Community Health. 2021; 12:21501327211019282. PMC: 8155772. DOI: 10.1177/21501327211019282. View

16.

Kamar N, Abravanel F, Marion O, Couat C, Izopet J, Del Bello A . Three Doses of an mRNA Covid-19 Vaccine in Solid-Organ Transplant Recipients. N Engl J Med. 2021; 385(7):661-662. PMC: 8262620. DOI: 10.1056/NEJMc2108861. View

17.

Liu E, Lee J, Loo A, Mazur S, Sultan S, Aull M . Casirivimab-Imdevimab (REGN-COV2) for Mild to Moderate SARS-CoV-2 Infection in Kidney Transplant Recipients. Kidney Int Rep. 2021; 6(11):2900-2902. PMC: 8418987. DOI: 10.1016/j.ekir.2021.08.032. View

18.

Gottlieb R, Nirula A, Chen P, Boscia J, Heller B, Morris J . Effect of Bamlanivimab as Monotherapy or in Combination With Etesevimab on Viral Load in Patients With Mild to Moderate COVID-19: A Randomized Clinical Trial. JAMA. 2021; 325(7):632-644. PMC: 7821080. DOI: 10.1001/jama.2021.0202. View

19.

Weinreich D, Sivapalasingam S, Norton T, Ali S, Gao H, Bhore R . REGEN-COV Antibody Combination and Outcomes in Outpatients with Covid-19. N Engl J Med. 2021; 385(23):e81. PMC: 8522800. DOI: 10.1056/NEJMoa2108163. View

20.

DeFrancesco L . COVID-19 antibodies on trial. Nat Biotechnol. 2020; 38(11):1242-1252. PMC: 7576980. DOI: 10.1038/s41587-020-0732-8. View