Anti SARS-CoV-2 Monoclonal Antibodies in Pre-Exposure or Post-Exposure in No- or Weak Responder to Vaccine Kidney Transplant Recipients: Is One Strategy Better than Another?

Publication date: Feb 29, 2024

Background: Kidney transplant recipients (KTRs) are likely to develop severe COVID-19 and are less well-protected by vaccines than immunocompetent subjects. Thus, the use of neutralizing anti-SARS-CoV-2 monoclonal antibodies (mAbs) to confer a passive immunity appears attractive in KTRs. Methods: This retrospective monocentric cohort study was conducted between 1 January 2022 and 30 September 2022. All KTRs with a weak antibody response one month after three doses of mRNA vaccine (anti spike IgG < 264 (BAU/mL)) have received tixagevimab-cilgavimab in pre-exposure (group 1), post-exposure (group 2) or no specific treatment (group 3). We compared COVID-19 symptomatic hospitalizations, including intensive care unit hospitalizations, oxygen therapy, and death, between the three groups. Results: A total of 418 KTRs had SARS-CoV-2 infection in 2022. During the study period, we included 112 KTRs in group 1, 40 KTRs in group 2, and 27 KTRs in group 3. The occurrence of intensive care unit hospitalization, oxygen therapy, and COVID-19 death was significantly increased in group 3 compared to group 1 or 2. In group 3, 5 KTRs (18. 5%) were admitted to the intensive care unit, 7 KTRs (25. 9%) needed oxygen therapy, and 3 KTRs (11. 1%) died. Patients who received tixagevimab-cilgavimab pre- or post-exposure had similar outcomes. Conclusions: This retrospective real-life study supports the relative effectiveness of tixagevimab-cilgavimab on COVID-19 infection caused by Omicron, used as a pre- or post-exposure therapy. The continued evolution of Omicron variants has made tixagevimab-cilgavimab ineffective and reinforces the need for new therapeutic monoclonal antibodies for COVID-19 active on new variants.

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Concepts Keywords
Attractive Antibodies, Monoclonal
Kidney Antibodies, Monoclonal
Month Antibodies, Viral
Therapy Antibodies, Viral
Vaccines Cohort Studies
Kidney Transplantation
kidney transplantation
monoclonal antibodies
Retrospective Studies
Transplant Recipients


Type Source Name
disease VO vaccine
drug DRUGBANK Tropicamide
disease MESH COVID-19
drug DRUGBANK Oxygen
disease MESH death
pathway REACTOME SARS-CoV-2 Infection
disease VO effectiveness
disease MESH infection
disease VO ineffective
disease VO vaccination
disease VO dose
disease VO vaccinated
drug DRUGBANK Coenzyme M
disease VO passive immunization
disease IDO history
disease VO protocol
disease VO injection
disease VO unvaccinated
disease IDO symptom
disease MESH rhinitis
drug DRUGBANK Dexamethasone
disease MESH Acute kidney injury
drug DRUGBANK Belatacept
drug DRUGBANK Tacrolimus
disease VO age
disease MESH Glomerulonephritis
disease MESH Hypertension
disease MESH Diabetes mellitus
disease MESH Cardiac disease
disease MESH Vascular disease
disease MESH Cancer
drug DRUGBANK Mycophenolic acid
drug DRUGBANK Azathioprine
drug DRUGBANK Ciclosporin
drug DRUGBANK Sirolimus
disease VO immunized
disease VO organization
disease VO population
disease IDO susceptibility
disease VO titer
disease VO effective
disease VO time
disease MESH emergency
drug DRUGBANK Ritonavir
disease MESH morbidity
disease IDO cell
disease MESH immunocompromised patients
disease VO Canada
disease IDO host

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