Impact of Immunosuppressive Therapy, Vaccination, and Monoclonal Antibody Use With Outcomes in Liver and Kidney Transplant Recipients With COVID‐19: A Retrospective Study

Abstract

Background and AimPatients who have undergone solid organ transplantation are at an elevated risk of severe coronavirus disease (COVID‐19) because of post‐transplantation immunosuppressive therapy. However, optimization of vaccination, modification of immunosuppression, and implementation of monoclonal antibody (mAb) therapy in transplant recipients with COVID‐19 is uncertain.MethodsA retrospective cross‐sectional study was conducted on patients who underwent liver or kidney transplants and were diagnosed with COVID‐19. The association of several vaccine doses, mycophenolate therapy, and mAB therapy with mortality outcomes after COVID‐19 diagnosis (3 and 6 months), hospitalization, and length of hospital stay were assessed.ResultsThis study included 255 patients with a median age of 59 (23–89) were included. Many COVID‐19 vaccine doses were not associated with any outcome; however, patients with a liver transplanted with mycophenolate had higher 3‐month (19% vs. 0%; p = 0.02) and 6‐month (21% vs. 0%; p = 0.01) mortality rates than those who did not. In addition, transplant recipients who received mAb therapy for COVID‐19 were less likely to be hospitalized (37% vs. 68%; p < 0.001).ConclusionsFor organ transplant recipients with COVID‐19, vaccination alone may not be an optimal strategy for preventing serious outcomes. Rather, the types of organ transplant, immunosuppressive therapy (particularly mycophenolate), and COVID‐19 treatment strategy should be synergistically considered to promote an optimal therapeutic dynamic for a vulnerable population.