Impact of Immunosuppressive Therapy, Vaccination, and Monoclonal Antibody Use With Outcomes in Liver and Kidney Transplant Recipients With COVID-19: A Retrospective Study

Overview

Journal JGH Open

Specialty Gastroenterology

Date 2024 Dec 6

PMID 39639985

Authors

Ashley Francis

Ammad Javaid Chaudhary

Abdullah Sohail

Zahid I Tarar

Ali Jaan

Joseph P Cavataio

Sara Farooqui

Adarsh Varma

Syed-Mohammed Jafri

Affiliations

Soon will be listed here.

Abstract

Background And Aim: Patients who have undergone solid organ transplantation are at an elevated risk of severe coronavirus disease (COVID-19) because of post-transplantation immunosuppressive therapy. However, optimization of vaccination, modification of immunosuppression, and implementation of monoclonal antibody (mAb) therapy in transplant recipients with COVID-19 is uncertain.

Methods: A retrospective cross-sectional study was conducted on patients who underwent liver or kidney transplants and were diagnosed with COVID-19. The association of several vaccine doses, mycophenolate therapy, and mAB therapy with mortality outcomes after COVID-19 diagnosis (3 and 6 months), hospitalization, and length of hospital stay were assessed.

Results: This study included 255 patients with a median age of 59 (23-89) were included. Many COVID-19 vaccine doses were not associated with any outcome; however, patients with a liver transplanted with mycophenolate had higher 3-month (19% vs. 0%; = 0.02) and 6-month (21% vs. 0%; = 0.01) mortality rates than those who did not. In addition, transplant recipients who received mAb therapy for COVID-19 were less likely to be hospitalized (37% vs. 68%; < 0.001).

Conclusions: For organ transplant recipients with COVID-19, vaccination alone may not be an optimal strategy for preventing serious outcomes. Rather, the types of organ transplant, immunosuppressive therapy (particularly mycophenolate), and COVID-19 treatment strategy should be synergistically considered to promote an optimal therapeutic dynamic for a vulnerable population.

References

Meunier L, Sanavio M, Dumortier J, Meszaros M, Faure S, Bedoya J . Mycophenolate mofetil decreases humoral responses to three doses of SARS-CoV-2 vaccine in liver transplant recipients. Liver Int. 2022; 42(8):1872-1878. PMC: 9115190. DOI: 10.1111/liv.15258. View

Kantauskaite M, Muller L, Kolb T, Fischer S, Hillebrandt J, Ivens K . Intensity of mycophenolate mofetil treatment is associated with an impaired immune response to SARS-CoV-2 vaccination in kidney transplant recipients. Am J Transplant. 2021; 22(2):634-639. PMC: 8653081. DOI: 10.1111/ajt.16851. View

Hardgrave H, Wells A, Nigh J, Klutts G, Krinock D, Osborn T . COVID-19 Mortality in Vaccinated vs. Unvaccinated Liver & Kidney Transplant Recipients: A Single-Center United States Propensity Score Matching Study on Historical Data. Vaccines (Basel). 2022; 10(11). PMC: 9694459. DOI: 10.3390/vaccines10111921. View

Chen P, Behre G, Hebert C, Kumar P, Farmer Macpherson L, Graham-Clarke P . Bamlanivimab and Etesevimab Improve Symptoms and Associated Outcomes in Ambulatory Patients at Increased Risk for Severe Coronavirus Disease 2019: Results From the Placebo-Controlled Double-Blind Phase 3 BLAZE-1 Trial. Open Forum Infect Dis. 2022; 9(5):ofac172. PMC: 9045956. DOI: 10.1093/ofid/ofac172. View

Yip T, Lui G, Wong V, Chow V, Ho T, Li T . Liver injury is independently associated with adverse clinical outcomes in patients with COVID-19. Gut. 2020; 70(4):733-742. DOI: 10.1136/gutjnl-2020-321726. View

Teoh J, Yip T, Lui G, Wong V, Chow V, Ho T . Risks of AKI and Major Adverse Clinical Outcomes in Patients with Severe Acute Respiratory Syndrome or Coronavirus Disease 2019. J Am Soc Nephrol. 2021; 32(4):961-971. PMC: 8017544. DOI: 10.1681/ASN.2020071097. View

Azzi Y, Parides M, Alani O, Loarte-Campos P, Bartash R, Forest S . COVID-19 infection in kidney transplant recipients at the epicenter of pandemics. Kidney Int. 2020; 98(6):1559-1567. PMC: 7561527. DOI: 10.1016/j.kint.2020.10.004. View

Cravedi P, Mothi S, Azzi Y, Haverly M, Farouk S, Perez-Saez M . COVID-19 and kidney transplantation: Results from the TANGO International Transplant Consortium. Am J Transplant. 2020; 20(11):3140-3148. PMC: 7405285. DOI: 10.1111/ajt.16185. View

Kutzler H, Kuzaro H, Serrano O, Feingold A, Morgan G, Cheema F . Initial experience of bamlanivimab monotherapy use in solid organ transplant recipients. Transpl Infect Dis. 2021; 23(5):e13662. DOI: 10.1111/tid.13662. View

10.

Salles M, Sens Y, Boas L, Machado C . Influenza virus vaccination in kidney transplant recipients: serum antibody response to different immunosuppressive drugs. Clin Transplant. 2009; 24(1):E17-23. DOI: 10.1111/j.1399-0012.2009.01095.x. View

11.

Yin S, Wang X, Song T . Tacrolimus Use and COVID-19 Infection in Patients After Solid Organ Transplantation. Gastroenterology. 2021; 161(2):728-730.e1. PMC: 7848533. DOI: 10.1053/j.gastro.2021.01.223. View

12.

Chen X, Luo D, Mei B, Du J, Liu X, Xie H . Immunogenicity of COVID-19 vaccines in solid organ transplant recipients: a systematic review and meta-analysis. Clin Microbiol Infect. 2022; 29(4):441-456. PMC: 9733302. DOI: 10.1016/j.cmi.2022.12.004. View

13.

Wu D, Robb M, Forsythe J, Bradley C, Cairns J, Draper H . Recipient Comorbidity and Survival Outcomes After Kidney Transplantation: A UK-wide Prospective Cohort Study. Transplantation. 2019; 104(6):1246-1255. DOI: 10.1097/TP.0000000000002931. View

14.

Sajgure A, Kulkarni A, Joshi A, Sajgure V, Pathak V, Melinkeri R . Safety and efficacy of mycophenolate in COVID-19: a nonrandomised prospective study in western India. Lancet Reg Health Southeast Asia. 2023; 11:100154. PMC: 9874052. DOI: 10.1016/j.lansea.2023.100154. View

15.

Coll E, Fernandez-Ruiz M, Sanchez-Alvarez J, Martinez-Fernandez J, Crespo M, Gayoso J . COVID-19 in transplant recipients: The Spanish experience. Am J Transplant. 2020; 21(5):1825-1837. PMC: 9906239. DOI: 10.1111/ajt.16369. View

16.

Sarrell B, Bloch K, El Chediak A, Kumm K, Tracy K, Forbes R . Monoclonal antibody treatment for COVID-19 in solid organ transplant recipients. Transpl Infect Dis. 2021; 24(1):e13759. PMC: 8646855. DOI: 10.1111/tid.13759. View

17.

Joerns J, Bollineni S, Mahan L, Mohanka M, Lawrence A, Timofte I . High-dose Mycophenolate Use at Vaccination Is Independently Associated With Breakthrough COVID-19 Among Lung Transplant Patients. Transplantation. 2022; 106(5):e271-e274. PMC: 9038231. DOI: 10.1097/TP.0000000000004089. View

18.

Requiao-Moura L, Modelli de Andrade L, Sandes-Freitas T, Cristelli M, Viana L, Nakamura M . The Mycophenolate-based Immunosuppressive Regimen Is Associated With Increased Mortality in Kidney Transplant Patients With COVID-19. Transplantation. 2022; 106(10):e441-e451. PMC: 9521389. DOI: 10.1097/TP.0000000000004251. View

19.

Kolla E, Weill A, Zaidan M, De Martin E, De Verdiere S, Semenzato L . COVID-19 Hospitalization in Solid Organ Transplant Recipients on Immunosuppressive Therapy. JAMA Netw Open. 2023; 6(11):e2342006. PMC: 10630896. DOI: 10.1001/jamanetworkopen.2023.42006. View

20.

Sandoval M, Nguyen D, Huang H, Yi S, Ghobrial R, Gaber A . COVID-19 mortality may be reduced among fully vaccinated solid organ transplant recipients. PLoS One. 2022; 17(12):e0279222. PMC: 9770372. DOI: 10.1371/journal.pone.0279222. View