COVID-19 Infection With the Omicron SARS-CoV-2 Variant in a Cohort of Kidney and Kidney Pancreas Transplant Recipients: Clinical Features, Risk Factors, and Outcomes

Wong, Germaine; Rowlandson, Matthew; Sabanayagam, Dharshana; Ginn, Andrew N.; Kable, Kathy; Sciberras, Frederika; Au, Eric; Draper, Jenny; Arnott, Alicia; Sintchenko, Vitali; Dwyer, Dominic E.; Chen, Sharon C.-A.; Kok, Jen

doi:10.1097/tp.0000000000004203

Cited by 25 publications

(21 citation statements)

References 32 publications

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“…However, 11.2% of LTR with breakthrough infections still required hospitalization for COVID-19-associated complications despite fulfilling the recommended vaccination status. These results are in line with mortality (2–10%) and hospitalization rates (3–56%) that were found in SOT [ 25 , 36 , 37 , 38 ] and a small Spanish single-center study that included 30 LTR with a hospitalization and mortality rate of 3.3% [ 25 ].…”

Section: Discussionsupporting

confidence: 86%

Clinical Outcomes of SARS-CoV-2 Breakthrough Infections in Liver Transplant Recipients during the Omicron Wave

Herting

Jahnke-Triankowski

Harberts

et al. 2023

Viruses

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At the start of the pandemic, liver transplant recipients (LTR) were at high risk of developing severe COVID-19. Here, the outcomes of breakthrough infections in fully vaccinated LTR (n = 98) during the Omicron wave were assessed. In most patients, a mild disease course was observed, but 11 LTR (11.2%) required hospitalization for COVID-19-related complications. All patients survived. The LTR requiring hospitalization were older (67 years vs. 54 years; p < 0.001), had a higher Charlson comorbidity index (9 vs. 5; p < 0.001), and a lower anti-S RBD titer (Roche Elecsys) prior to infection (508.3 AU/mL vs. 2044 AU/mL; p = 0.03). Long-lasting symptoms for ≥4 weeks were reported by 37.5% of LTR (30/80). Risk factors in LTR included female sex (p = 0.01; Odds Ratio (OR) = 4.92 (95% confidence interval (CI) (1.5–16.5)) and dyspnea (p = 0.009; OR = 7.2 (95% CI (1.6–31.6)) during infection. Post-infection high anti-S RBD antibody levels were observed in LTR, and healthy controls (HC), while the cellular immune response, assessed by interferon-gamma release assay (EUROIMMUN), was significantly lower in LTR compared with HC (p < 0.001). In summary, in fully vaccinated LTR, SARS-CoV-2 breakthrough infections during the Omicron wave led to mild disease courses in the majority of patients and further boosted the humoral and cellular hybrid anti-SARS-CoV-2-directed immune response. While all patients survived, older and multimorbid LTR with low baseline antibody titers after vaccination still had a substantial risk for a disease course requiring hospitalization due to COVID-19-related complications.

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Section: Discussionsupporting

confidence: 86%

Clinical Outcomes of SARS-CoV-2 Breakthrough Infections in Liver Transplant Recipients during the Omicron Wave

Herting

Jahnke-Triankowski

Harberts

et al. 2023

Viruses

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“…Several studies have examined the outcomes of anti-spike monoclonal antibody therapy in high-risk patients, including specific transplant populations. [6][7][8][9] While much of these data predate the Omicron era, these studies have largely demonstrated overall good outcomes, including low rates of progression to severe infection, hospitalization, and death. Previous anti-spike monoclonal antibody therapies have largely been considered equivalent in effectiveness, assuming the current circulating variant has adequate susceptibility.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have examined the outcomes of anti‐spike monoclonal antibody therapy in high‐risk patients, including specific transplant populations 6–9 . While much of these data predate the Omicron era, these studies have largely demonstrated overall good outcomes, including low rates of progression to severe infection, hospitalization, and death.…”

Section: Discussionmentioning

confidence: 99%

“…In January 2022, sotrovimab was the sole anti‐spike neutralizing monoclonal antibody therapy authorized for use. Real‐world retrospective data have suggested that sotrovimab was effective in reducing hospitalization and mortality among SOTRs with COVID‐19 when compared to untreated patients 8,9 . However, SARS‐CoV‐2 Omicron further evolved into BA.2 subvariants with reduced susceptibility to sotrovimab.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of bebtelovimab and sotrovimab treatment of solid organ transplant recipients with mild‐to‐moderate coronavirus disease 2019 during the Omicron epoch

Yetmar

Beam

O’Horo

et al. 2022

Transplant Infectious Dis

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Background: Solid organ transplant recipients (SOTRs) are at high-risk for severe infection from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Anti-spike monoclonal antibodies are currently utilized under emergency use authorization to prevent hospitalization in high-risk individuals with coronavirus disease 2019 (COVID-19), including SOTRs. However, clinical data for bebtelovimab, the sole currently available anti-spike monoclonal antibody for COVID-19, is limited. Methods: We conducted a retrospective cohort study of adult SOTRs diagnosed with mild-to-moderate COVID-19 from January 2022 through May 2022 who received either bebtelovimab or sotrovimab. The primary outcome was COVID-19-related hospitalization within 30 days of COVID-19 diagnosis. Data were analyzed with Fisher's exact test.Results: Among 361 SOTRs, 92 (25.5%) received bebtelovimab and 269 (74.5%) received sotrovimab. The most common organ transplant was a kidney (42.4%). SOTRs who received bebtelovimab had a higher proportion who had received a booster SARS-CoV-2 vaccine dose and had received their last vaccination dose more recently. Eleven (3.0%) SOTRs were hospitalized, and rates of hospitalization were similar between monoclonal antibody groups (3.3% versus 3.0%; p > .99). Three patients required admission to an intensive care unit, all of who received sotrovimab. Four (1.1%) patients died within 30 days of COVID-19 diagnosis, two from each group.Conclusions: SOTRs with mild-to-moderate COVID-19 who received bebtelovimab had similar rates of COVID-19-related hospitalization as those who received sotrovimab. While differences in vaccination rates and viral subvariants could act as confounders, bebtelovimab appears to be of similar effectiveness as sotrovimab.

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“…In this study, we examined unvaccinated KT patients infected with the Omicron BA. imaging, 17% required ICU admission for treatment, while 75% died [15]. A study reported that the mortality rate among 36 KT recipients infected with SARS-CoV-2 was 28% [16].…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics and outcomes of unvaccinated kidney transplant patients infected with SARS-CoV-2 omicron subvariant BA.5.2

Qu,

Zhuang,

Duan

et al. 2023

Preprint

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Background Kidney transplant (KT) recipients, who are chronically immunocompromised, face increased risks due to COVID-19 and lower vaccination rates. Limited knowledge exists regarding the clinical characteristics of unvaccinated KT patients with COVID-19. This study aimed to examine the clinical features and outcomes of unvaccinated KT patients infected with SARS-CoV-2 omicron subvariant BA.5.2. Methods The study enrolled 36 unvaccinated KT patients with COVID-19 and compared them to 20 infected control cases without underlying medical conditions. Clinical characteristics, laboratory tests, treatment regimens, and outcomes were analyzed. RT-PCR confirmed SARS-CoV-2 Omicron BA.5.2 subvariant infection. Results The KT patients experienced severe disease, with 66.7% classified as severe/critical illness. Dyspnea on admission, lower blood leukocyte and lymphocyte counts, hemoglobin levels, and serum albumin levels were more prevalent in the KT group compared to the control group. Severe/critical illness was associated with factors such as age, diabetes mellitus, lung infection CT score, and elevated levels of D-dimer, IL-6, CRP, Procalcitonin, and ferritin. Blood lymphocyte counts and serum albumin levels were significantly lower in the severe/critical illness group in KT patients. Treatment included discontinuation of anti-metabolic drugs, reduction, or discontinuation of calcineurin inhibitor drugs, antiviral therapy, and early patient-tailored nutritional support. Acute kidney injury was observed in 19.4% of cases, and four patients died during the observation period. Conclusions Early diagnosis, personalized treatment regimens, and diligent monitoring are crucial for unvaccinated KT patients with COVID-19. These findings contribute to understanding the clinical characteristics and management of COVID-19 in the KT population.

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COVID-19 Infection With the Omicron SARS-CoV-2 Variant in a Cohort of Kidney and Kidney Pancreas Transplant Recipients: Clinical Features, Risk Factors, and Outcomes

Cited by 25 publications

References 32 publications

Clinical Outcomes of SARS-CoV-2 Breakthrough Infections in Liver Transplant Recipients during the Omicron Wave

Clinical Outcomes of SARS-CoV-2 Breakthrough Infections in Liver Transplant Recipients during the Omicron Wave

Outcomes of bebtelovimab and sotrovimab treatment of solid organ transplant recipients with mild‐to‐moderate coronavirus disease 2019 during the Omicron epoch

Clinical characteristics and outcomes of unvaccinated kidney transplant patients infected with SARS-CoV-2 omicron subvariant BA.5.2

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