COVID-19 Outcomes in Kidney Transplant Recipients Receiving Tixagevimab/Cilgavimab for Pre-exposure Prophylaxis: A Single-center Retrospective Study.

Publication date: Sep 17, 2025

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. 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. 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. 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.

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