Is the Omicron variant truly less virulent in solid organ transplant recipients?

Abstract

Solid organ transplant (SOT) recipients are at high risk for severe disease with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Emerging variants of concern have disproportionately affected this population. Data on severity and outcomes with the Omicron variant in SOT recipients are limited. Thus we conducted this single‐center, retrospective cohort study of SOT recipients diagnosed with SARS‐CoV‐2 infection from December 18, 2021 to January 18, 2022, when prevalence of the Omicron variant was more than 80%‐95% in the community. Univariate and multivariate logistic regression analysis was performed to identify risk factors for hospital admission. We identified 166 SOT patients: 112 (67.5%) kidney, 22 (13.3%) liver, 10 (6.0%) lung, seven (4.2%) heart, and 15 (9.0%) combined transplants. SARS‐CoV‐2 vaccine series was completed in 59 (35.5%) recipients. Ninety‐nine (59.6%) and 13 (7.8%) recipients received casirivimab/imdevimab and sotrovimab, respectively. Fifty‐three (32%) recipients required hospital admission, of which 19 (35.8%) required intensive care unit level of care. Median follow‐up was 50 (interquartile range, 25‐59) days, with mortality reported in six (3.6%) patients. Risk factors identified for hospital admission were African American race (p < .001, odds ratio [OR] 4.00, 95% confidence interval [CI] 1.84‐8.70), history of coronary artery disease (p = .031, OR 3.50, 95% CI 1.12‐10.87), and maintenance immunosuppression with corticosteroids (p = .048, OR 2.00, 95% CI 1.01‐4.00). In conclusion, contrary to that in the general population, we found a higher hospital admission rate in SOT recipients with omicron variant infection. Further studies to investigate the efficacy of newer treatments are necessary, even as outcomes continue to improve.

Early Treatment with Monoclonal Antibodies or Convalescent Plasma Reduces Mortality in Non-Vaccinated COVID-19 High-Risk Patients

“…The plasma units that had a neutralization titer of at least 1:160 were administered to patients in an AB0-compatible manner. Neutralizing antibody titers were determined as previously described [ 34 ]. In 10 of 11 patients, therapy was performed with two plasma units of 200–280 mL each on day 1 and 3; in one patient, a third unit was applied on day 5.…”

“…In consequence, in the European Union most available mAb are no longer recommended and in the United States no longer authorized to treat COVID-19. Of note, while the presence of the Omicron variant has been associated with a lower severity of COVID-19 in the general population, recent data indicate that pre-diseased and immune-compromised patients remain at high risk for morbidity and mortality from COVID-19 [ 34 , 35 ]. Thus, rapidly available and affordable treatment options are still urgently needed.…”

Systemic and mucosal adaptive immunity to SARS-CoV-2 during the Omicron wave in patients with chronic lymphocytic leukemia

“…The emergence of the B1.1.529 (Omicron) variant of SARS-CoV-2 (11) has changed the course of the COVID-19 pandemic due to its less aggressive clinical course (12,13) and reduced risk of hospitalization (14), even though this is still uncertain in immunosuppressed subgroups, such as solid organ transplanted patients (15) and patients having received CD20 mAbs (16). Moreover, the lower proportion of cases with severe disease in the general population may be in uenced by the high number of infected individuals (17).…”

Tixagevimab-cilgavimab as an early treatment for COVID-19 in kidney transplant recipients

“…4 In addition, there have been reports of a greater mortality in transplanted patients than in general population during the Omicron wave. 5–7…”

“…4 In addition, there have been reports of a greater mortality in transplanted patients than in general population during the Omicron wave. [5][6][7] Anti-SARS-CoV-2 monoclonal antibodies (mAbs) have been successfully used for pre-and post-exposure prophylaxis and as an early treatment for patients at high risk of developing severe COVID-19 -including KTRs. [8][9][10][11][12] Currently, their administration is the mainstay of COVID-19 management in solid organ transplant recipients who did not develop a sufficient humoral immune response following vaccination.…”