BACKGROUND Kidney transplant recipients(KTRs)are most vulnerable to infection in the first year after transplantation.Tixagevimab and cilgavimab are neutralizing monoclonal antibodies directed against different epitop...BACKGROUND Kidney transplant recipients(KTRs)are most vulnerable to infection in the first year after transplantation.Tixagevimab and cilgavimab are neutralizing monoclonal antibodies directed against different epitopes of the receptor-binding domain of the severe acute respiratory syndrome coronavirus 2 spike protein.The purpose of this study is to report experience with tixagevimab/cilgavimab administered to KTRs who were within 1 year of transplantation.AIM To describe outcomes of KTRs who received tixagevimab/cilgavimab early posttransplant to prevent coronavirus disease 2019(COVID-19).METHODS This is a single-center retrospective cohort study of adult KTRs who underwent kidney transplantation from January 1,2022 to September 30,2022 and received tixagevimab/cilgavimab 300 mg/300 mg for prevention of COVID-19.Outcomes of interest were adverse events associated with tixagevimab/cilgavimab,COVID-19 breakthrough infection and COVID-19-associated hospitalization and complications.We also conducted a systematic review of the literature for the use of tixagevimab/cilgavimab as pre-exposure prophylaxis for COVID-19 in solid organ transplant recipients(SOTRs)from inception to December 31,2023.RESULTS There were 104 patients included with median age of 50 years(range 21-72 years).Omicron strain of the COVID-19 virus was the predominantly circulating variant at the time of current study.Patients testing positive for COVID-19 were given tixagevimab/cilgavimab for prophylaxis of complications during the median of 3 days(range 0-201 days)after kidney transplant,of whom 97(93.3%)received the antibodies prior to discharge.No discernable adverse effects attributable to the medication were observed during the time they received prophylaxis.The efficacy of the drug assessed through the absence of breakthrough infections were observed in 91 patients.13(12.5%)patients developed COVID-19 breakthrough infections during an overall median follow-up period of 125 days(range 10-257 days)after tixagevimab/cilgavimab.These infections were observed at median 105 days(range 6-211 days)after receiving the prophylactic medication.5(4.8%)of overall patients required hospitalization and there were no reported deaths in the cohort.Findings of the systematic review were consistent with our findings wherein tixagevimab/cilgavimab was well tolerated by SOTRs.CONCLUSION Tixagevimab/cilgavimab has a favorable safety profile when administered in newly transplanted kidney recipients.Although breakthrough infections were not uncommon,there was a low rate of hospitalization and no deaths.This study highlights the need to examine the efficacy of novel monoclonal antibodies administered for COVID-19 prophylaxis in newly transplanted recipients.展开更多
The number of older end-stage renal disease patients being referred for kidney transplantation continues to increase. This rise is occurring alongside the continually increasing prevalence of older end-stage renal dis...The number of older end-stage renal disease patients being referred for kidney transplantation continues to increase. This rise is occurring alongside the continually increasing prevalence of older end-stage renal disease patients. Although older kidney transplant recipients have decreased patient and graft survival compared to younger patients, transplantation in this patient population is pursued due to the survival advantage that it confers over remaining on the deceased donor waiting list. The upper limit of age and the extent of comorbidity and frailty at which transplantation ceases to be advantageous is not known. Transplant physicians are therefore faced with the challenge of determining who among older patients are appropriate candidates for kidney transplantation. This is usually achieved by means of an organ systemsbased medical evaluation with particular focus given to cardiovascular health. More recently, global measures of health such as functional status and frailty are increasingly being recognized as potential tools in risk stratifying kidney transplant candidates. For those candidates who are deemed eligible, living donor transplantation should be pursued. This may mean accepting a kidney from an older living donor. In the absence of any living donor, the choice to accept lesser quality kidneys should be made while taking into account the organ shortage and expected waiting times on the deceased donor list. Appropriate counseling of patients should be a cornerstone in the evaluation process and includes a discussion regarding expected outcomes, expected waiting times in the setting of the new Kidney Allocation System, benefits of living donor transplantation and the acceptance of lesser quality kidneys.展开更多
文摘BACKGROUND Kidney transplant recipients(KTRs)are most vulnerable to infection in the first year after transplantation.Tixagevimab and cilgavimab are neutralizing monoclonal antibodies directed against different epitopes of the receptor-binding domain of the severe acute respiratory syndrome coronavirus 2 spike protein.The purpose of this study is to report experience with tixagevimab/cilgavimab administered to KTRs who were within 1 year of transplantation.AIM To describe outcomes of KTRs who received tixagevimab/cilgavimab early posttransplant to prevent coronavirus disease 2019(COVID-19).METHODS This is a single-center retrospective cohort study of adult KTRs who underwent kidney transplantation from January 1,2022 to September 30,2022 and received tixagevimab/cilgavimab 300 mg/300 mg for prevention of COVID-19.Outcomes of interest were adverse events associated with tixagevimab/cilgavimab,COVID-19 breakthrough infection and COVID-19-associated hospitalization and complications.We also conducted a systematic review of the literature for the use of tixagevimab/cilgavimab as pre-exposure prophylaxis for COVID-19 in solid organ transplant recipients(SOTRs)from inception to December 31,2023.RESULTS There were 104 patients included with median age of 50 years(range 21-72 years).Omicron strain of the COVID-19 virus was the predominantly circulating variant at the time of current study.Patients testing positive for COVID-19 were given tixagevimab/cilgavimab for prophylaxis of complications during the median of 3 days(range 0-201 days)after kidney transplant,of whom 97(93.3%)received the antibodies prior to discharge.No discernable adverse effects attributable to the medication were observed during the time they received prophylaxis.The efficacy of the drug assessed through the absence of breakthrough infections were observed in 91 patients.13(12.5%)patients developed COVID-19 breakthrough infections during an overall median follow-up period of 125 days(range 10-257 days)after tixagevimab/cilgavimab.These infections were observed at median 105 days(range 6-211 days)after receiving the prophylactic medication.5(4.8%)of overall patients required hospitalization and there were no reported deaths in the cohort.Findings of the systematic review were consistent with our findings wherein tixagevimab/cilgavimab was well tolerated by SOTRs.CONCLUSION Tixagevimab/cilgavimab has a favorable safety profile when administered in newly transplanted kidney recipients.Although breakthrough infections were not uncommon,there was a low rate of hospitalization and no deaths.This study highlights the need to examine the efficacy of novel monoclonal antibodies administered for COVID-19 prophylaxis in newly transplanted recipients.
文摘The number of older end-stage renal disease patients being referred for kidney transplantation continues to increase. This rise is occurring alongside the continually increasing prevalence of older end-stage renal disease patients. Although older kidney transplant recipients have decreased patient and graft survival compared to younger patients, transplantation in this patient population is pursued due to the survival advantage that it confers over remaining on the deceased donor waiting list. The upper limit of age and the extent of comorbidity and frailty at which transplantation ceases to be advantageous is not known. Transplant physicians are therefore faced with the challenge of determining who among older patients are appropriate candidates for kidney transplantation. This is usually achieved by means of an organ systemsbased medical evaluation with particular focus given to cardiovascular health. More recently, global measures of health such as functional status and frailty are increasingly being recognized as potential tools in risk stratifying kidney transplant candidates. For those candidates who are deemed eligible, living donor transplantation should be pursued. This may mean accepting a kidney from an older living donor. In the absence of any living donor, the choice to accept lesser quality kidneys should be made while taking into account the organ shortage and expected waiting times on the deceased donor list. Appropriate counseling of patients should be a cornerstone in the evaluation process and includes a discussion regarding expected outcomes, expected waiting times in the setting of the new Kidney Allocation System, benefits of living donor transplantation and the acceptance of lesser quality kidneys.
