Tixagevimab-Cilgavimab Decreases the Rate of SARS-CoV-2 Infection Among Solid Organ Transplant Recipients

Ava M Sanayei; Adriana Montalvan; Isabella Faria; Julia Ochalla; Martha Pavlakis; Barbra M Blair; Carolyn D Alonso; Michael Curry; Behnam Saberi

doi:10.1016/j.transproceed.2023.07.011

Tixagevimab-Cilgavimab Decreases the Rate of SARS-CoV-2 Infection Among Solid Organ Transplant Recipients

Transplant Proc. 2023 Oct;55(8):1784-1792. doi: 10.1016/j.transproceed.2023.07.011. Epub 2023 Sep 1.

Authors

Ava M Sanayei¹, Adriana Montalvan², Isabella Faria², Julia Ochalla¹, Martha Pavlakis³, Barbra M Blair⁴, Carolyn D Alonso⁴, Michael Curry¹, Behnam Saberi⁵

Affiliations

¹ Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
² Division of Transplant Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
³ Division of Nephrology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
⁴ Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
⁵ Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts. Electronic address: [email protected].

PMID: 37661468
DOI: 10.1016/j.transproceed.2023.07.011

Abstract

Background: SARS-CoV-2 infection in solid organ transplant (SOT) recipients is associated with high morbidity and mortality. Tixagevimab/cilgavimab monoclonal antibodies were previously authorized for pre-exposure prophylaxis for immunocompromised individuals. We aimed to determine if tixagevimab/cilgavimab could prevent breakthrough SARS-CoV-2 infection in SOT recipients.

Material and methods: We conducted a prospective single-center study of SOT recipients who received tixagevimab/cilgavimab compared with those who did not. Demographics, type of transplant, immunosuppression regimen, COVID-19 vaccination status, and tixagevimab/cilgavimab administration data were collected. Participants were interviewed for 6 months or until they tested positive for SARS-CoV-2, whichever came first. Kaplan-Meier SARS-CoV-2-free survival curves were created based on the tixagevimab/cilgavimab administration date and SARS-CoV-2 infection. The log-rank test was used for comparison. Univariate and multivariate Cox regression models were constructed.

Results: The study cohort included 323 patients. Two hundred forty-eight received tixagevimab/cilgavimab, and 75 did not (control). COVID-19 vaccination rate was higher among tixagevimab/cilgavimab recipients than nontixagevimab/cilgavimab recipients (99.6% vs 92.0%; P < .001). Twenty-six patients in the tixagevimab/cilgavimab group (10.5%) and 23 in the control group (30.7%) tested positive for SARS-CoV-2 infection (P < .001). In a multivariate analysis, receipt of tixagevimab/cilgavimab and duration from transplant were both associated with reduced risk of SARS-CoV-2 infection (hazard ratio 0.431; 95% CI 0.224-0.828 and hazard ratio 0.917; 95% CI 0.861-0.978, respectively).

Conclusion: During the study period, SOT recipients who received tixagevimab/cilgavimab had a significantly lower rate of SARS-CoV-2 infection. There were no differences in symptom frequency, illness severity, hospitalization rate, or treatment of SARS-CoV-2 infection.