Case Report of COVID-19 Infection After Kidney Transplant Treated With Casirivimab-Imdevimab and Mycophenolate Mofetil Changed to Everolimus

Abstract

Background Casirivimab-imdevimab is a cocktail of two monoclonal antibodies designed to prevent infection by SARS-CoV-2, the virus that causes COVID-19. Casirivimab-imdevimab has been approved in Japan for treating mild to moderate coronavirus disease (COVID-19); however, to the best of our knowledge, there are no reports of its use after kidney transplantation from a live donor. Everolimus, antineoplastic chemotherapy drug, is expected to be effective in inhibiting the spread of SARS-CoV-2 and preventing its replication, which may facilitate treatment. Here, we report a case of COVID-19 infection following kidney transplantation, that was initially treated with casirivimab-imdevimab and mycophenolate mofetil, but was later changed to everolimus. Case report A 47-year-old man underwent living donor kidney transplantation from his mother in 2017. Immunosuppression therapy was underway through the administration of tacrolimus, mycophenolate mofetil, and methylprednisolone. In early September 2021, he was diagnosed with COVID-19 and was hospitalized on Day 3 (Table 1). On hospitalization, mycophenolate mofetil was discontinued and casirivimab-imdevimab and heparin were started. The patient was started on everolimus on Day 5. The clinical course was successful without rejection (Fig. 1). There was no exacerbation of COVID-19; the patient's serum creatinine levels and renal function had otherwise remained stable. Conclusion We could safely treat a patient with casirivimab-imdevimab after kidney transplantation. It is suggested that casirivimab-imdevimab can prevent COVID-19 from becoming severe and can be administered without worsening renal function. In addition, everolimus may have inhibited the spread of the virus and prevented it from replicating.

Prevention and treatment strategies for kidney transplant recipients in the context of long-term existence of COVID-19

“…Dhand et al ( 56 ) reported using casirivimab/imdevimab for COVID-19 treatment in SOTRs, which could prevent further progression of COVID-19 in KTRs to a certain extent ( 57 ). In addition to the results of sotrovimab administration, Fernandes et al ( 38 ) showcased the positive outcomes of casirivimab/imdevimab administration in KTRs infected with the Omicron variant.…”

Mitigating Endemic COVID-19 Risks in Patients with Chronic Kidney Disease and Kidney Transplantation: A Narrative Review

“…Despite the increased risk of severe COVID-19 and death in KTRs due to chronic morbidities and immunosuppression, studies suggest that newer agents can be part of PrEP or early treatment strategies in early-diagnosed or mild COVID-19, serving as an alternative to vaccinations. A case report noted successful COVID-19 management without worsening the condition or organ rejection in a KTR receiving CAS-IMD, suggesting its potential role in preventing COVID-19 progression in KTRs [62].…”