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

Authors

Abhay Dhand, Transplant Infectious Diseases, Department of Medicine and Surgery, ACP-Transplant Center, Westchester Medical Center/New York Medical College, 100 Woods Road, Valhalla, NY 10595 USA.
Raymund R. Razonable, Division of Infectious Diseases, Department of Medicine and the William J von Leibig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN USA.

Author Type(s)

Faculty

Journal Title

Current Transplantation Reports

First Page

26

Last Page

34

Document Type

Article

Publication Date

1-1-2022

Department

Medicine

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.

Recommended Citation

Dhand, A., & Razonable, R. R. (2022). COVID-19 and Solid Organ Transplantation: Role of Anti-SARS-Cov-2 Monoclonal Antibodies. Current Transplantation Reports, 9 (1), 26-34. https://doi.org/10.1007/s40472-022-00357-2