Transplantation proceedings · 2025
COVID-19 Outcomes in Kidney Transplant Recipients Receiving Tixagevimab/Cilgavimab for Pre-exposure Prophylaxis: A Single-center Retrospective Study.
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Spencker Jakob Joachim, Mikhailov Michael, Bachmann Friederike, Choi Mira, Duettmann Wiebke, Eleftheriadis Georgios, Halleck Fabian, Naik Marcel G, Schrezenmeier Eva, Zukunft Bianca, Budde Klemens, Osmanodja Bilgin
Аннотация
BACKGROUND/AIM: Kidney transplant recipients (KTRs) show higher morbidity and mortality from COVID-19 than the general population and have an impaired response to vaccination. For patients without serological response to COVID-19 vaccination, pre-exposure prophylaxis with tixagevimab/cilgavimab is an option to achieve alternative immunization.
METHODS: We retrospectively analyzed COVID-19 incidence and outcomes in a single-center cohort of 104 KTRs who received tixagevimab/cilgavimab pre-exposure prophylaxis between March 16, 2022, and January 18, 2023, comparing them with 36 unvaccinated and 224 vaccinated KTRs without pre-exposure prophylaxis infected during the Omicron era.
RESULTS: During a median follow-up time of 7.4 months (IQR, 5.9-10.1 months) after pre-exposure prophylaxis, 36 KTRs (35%) experienced breakthrough SARS-CoV-2 infections, with 5 (5%) having recurrent infections. Among those with breakthrough infection, 4 (11%) were hospitalized, and 1 (3%) died from COVID-19. No serious adverse events have followed tixagevimab/cilgavimab administration. In comparison, unvaccinated KTRs had a 51.0% hospitalization rate and an 8.6% mortality rate, and vaccinated patients without pre-exposure prophylaxis had a 17.0% hospitalization rate and a 2.2% mortality rate.
CONCLUSION: These real-world data show that pre-exposure prophylaxis with tixagevimab/cilgavimab was a feasible alternative for patients without sufficient serological response to vaccination during a period of Omicron dominance. Novel therapeutics are necessary for variants resistant to tixagevimab/cilgavimab.
METHODS: We retrospectively analyzed COVID-19 incidence and outcomes in a single-center cohort of 104 KTRs who received tixagevimab/cilgavimab pre-exposure prophylaxis between March 16, 2022, and January 18, 2023, comparing them with 36 unvaccinated and 224 vaccinated KTRs without pre-exposure prophylaxis infected during the Omicron era.
RESULTS: During a median follow-up time of 7.4 months (IQR, 5.9-10.1 months) after pre-exposure prophylaxis, 36 KTRs (35%) experienced breakthrough SARS-CoV-2 infections, with 5 (5%) having recurrent infections. Among those with breakthrough infection, 4 (11%) were hospitalized, and 1 (3%) died from COVID-19. No serious adverse events have followed tixagevimab/cilgavimab administration. In comparison, unvaccinated KTRs had a 51.0% hospitalization rate and an 8.6% mortality rate, and vaccinated patients without pre-exposure prophylaxis had a 17.0% hospitalization rate and a 2.2% mortality rate.
CONCLUSION: These real-world data show that pre-exposure prophylaxis with tixagevimab/cilgavimab was a feasible alternative for patients without sufficient serological response to vaccination during a period of Omicron dominance. Novel therapeutics are necessary for variants resistant to tixagevimab/cilgavimab.