A Review of Treatment and Prevention of Coronavirus Disease 2019 among Solid Organ Transplant Recipients

Abstract

Therapeutic management of solid organ transplant (SOT) recipients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of coronavirus disease 2019 (COVID-19), may challenge healthcare providers given a paucity of clinical data specific to this cohort. Herein, we summarize and review the studies that have formed the framework for current COVID-19 consensus management guidelines. Our review focuses on COVID-19 treatment options including monoclonal antibody products, antiviral agents such as remdesivir, and immunomodulatory agents such as corticosteroids, interleukin inhibitors, and kinase inhibitors. We highlight the presence or absence of clinical data of these therapeutics related to the SOT recipient with COVID-19. We also describe data surrounding COVID-19 vaccination of the SOT recipient. Understanding the extent and limitations of observational and clinical trial data for the prevention and treatment of COVID-19 specific to the SOT population is crucial for optimal management. Although minimal data exist on clinical outcomes among SOT recipients treated with varying COVID-19 therapeutics, reviewing these agents and the studies that have led to their inclusion or exclusion in clinical management of COVID-19 highlights the need for further studies of these therapeutics in SOT patients with COVID-19.

Decline in Antibody Concentration 6 Months After Two Doses of SARS-CoV-2 BNT162b2 Vaccine in Solid Organ Transplant Recipients and Healthy Controls

“…Most previous studies have investigated short-term humoral responses up to 3 months after the first dose of SARS-CoV-2 mRNA vaccine in SOT recipients ( 5 , 6 , 10 – 18 , 34 ) and reported response rates similar to what we found 2 months after the first vaccination. The present study expands current knowledge by presenting data on both anti-RBD IgG concentration, neutralizing capacity of antibodies, and T-cell responses in SOT recipients and population controls with long-term follow-up.…”

“…Most previous studies have investigated short-term humoral responses up to 3 months after the first dose of SARS-CoV-2 mRNA vaccine in SOT recipients (5,6,(10)(11)(12)(13)(14)(15)(16)(17)(18)34) and reported response rates similar to what we found 2 months after the 27) reported data with 7 months of follow-up after the first dose of BNT162b2 or mRNA-1273 vaccine and found 72% of SOT recipients to have anti-spike IgG antibodies. We found 36% of SOT recipients to have a positive humoral response 6 months after the first vaccine dose.…”

“…We found increasing age, being less than 1 year from transplantation, use of mycophenolate or corticosteroids, being kidney or lung transplant recipient, and de novo non-skin cancer to be associated with humoral non-response 6 months after the first vaccination. Increasing age, use of mycophenolate, and shorter time from transplantation to vaccination have previously been found to be associated with humoral nonresponse up to 3 months after the first vaccine dose (5,6,10,11,15,16,21). Likewise, liver transplant recipients have been found to have a lower risk of humoral non-response compared to other organ groups (11,21).…”

“…Solid organ transplant (SOT) recipients receive immunosuppressive therapy to prevent allograft rejection, leaving them at higher risk of infections and infection-related morbidity and mortality (1). This may also be true for coronavirus disease 2019 (COVID-19) (2)(3)(4)(5)(6).…”

“…However, SOT recipients were not included in these trials (7)(8)(9). Reports on the short-term response to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) mRNA vaccines in SOT recipients indicate that the humoral response after two doses of vaccine (5,6,(10)(11)(12)(13)(14)(15)(16)(17)(18) is inferior to what was initially reported in immunocompetent populations (7,8).…”