COVID-19 Outcomes in Kidney Transplant Recipients Receiving Tixagevimab/Cilgavimab for Pre-exposure Prophylaxis: A Single-center Retrospective Study.

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Transplantation proceedings Pub Date : 2025-09-17 DOI:10.1016/j.transproceed.2025.06.021

Jakob Joachim Spencker, Michael Mikhailov, Friederike Bachmann, Mira Choi, Wiebke Duettmann, Georgios Eleftheriadis, Fabian Halleck, Marcel G Naik, Eva Schrezenmeier, Bianca Zukunft, Klemens Budde, Bilgin Osmanodja

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Abstract

Background/aim: Kidney transplant recipients (KTRs) show higher morbidity and mortality from COVID-19 than the general population and have an impaired response to vaccination. For patients without serological response to COVID-19 vaccination, pre-exposure prophylaxis with tixagevimab/cilgavimab is an option to achieve alternative immunization.

Methods: We retrospectively analyzed COVID-19 incidence and outcomes in a single-center cohort of 104 KTRs who received tixagevimab/cilgavimab pre-exposure prophylaxis between March 16, 2022, and January 18, 2023, comparing them with 36 unvaccinated and 224 vaccinated KTRs without pre-exposure prophylaxis infected during the Omicron era.

Results: During a median follow-up time of 7.4 months (IQR, 5.9-10.1 months) after pre-exposure prophylaxis, 36 KTRs (35%) experienced breakthrough SARS-CoV-2 infections, with 5 (5%) having recurrent infections. Among those with breakthrough infection, 4 (11%) were hospitalized, and 1 (3%) died from COVID-19. No serious adverse events have followed tixagevimab/cilgavimab administration. In comparison, unvaccinated KTRs had a 51.0% hospitalization rate and an 8.6% mortality rate, and vaccinated patients without pre-exposure prophylaxis had a 17.0% hospitalization rate and a 2.2% mortality rate.

Conclusion: These real-world data show that pre-exposure prophylaxis with tixagevimab/cilgavimab was a feasible alternative for patients without sufficient serological response to vaccination during a period of Omicron dominance. Novel therapeutics are necessary for variants resistant to tixagevimab/cilgavimab.

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肾移植受者接受替沙昔单抗/西加维单抗暴露前预防的COVID-19结局：一项单中心回顾性研究

背景/目的：肾移植受者（KTRs）的COVID-19发病率和死亡率高于一般人群，并且对疫苗接种的反应较差。对于对COVID-19疫苗接种无血清学反应的患者，使用替沙吉维单抗/西gavimab进行暴露前预防是实现替代免疫的一种选择。方法：回顾性分析2022年3月16日至2023年1月18日期间接受替沙吉维单/西gavimab暴露前预防的104名KTRs的COVID-19发病率和结局，并将其与36名未接种疫苗的KTRs和224名接种疫苗的KTRs进行比较，这些KTRs在欧米克隆时代感染了暴露前预防。结果：暴露前预防后的中位随访时间为7.4个月（IQR, 5.9-10.1个月），36例患者（35%）出现突破性SARS-CoV-2感染，5例患者（5%）出现复发感染。突破感染者中有4人（11%）住院，1人（3%）死亡。替沙吉维单/西加维单后未发生严重不良事件。相比之下，未接种疫苗的KTRs住院率为51.0%，死亡率为8.6%，未接种疫苗的暴露前预防接种的患者住院率为17.0%，死亡率为2.2%。结论：这些真实世界的数据表明，对于在欧米克隆优势期对疫苗接种没有足够血清学反应的患者，暴露前预防使用替沙吉维单抗/西gavimab是一种可行的选择。对替沙吉维单/西加维单耐药的变异需要新的治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Transplantation proceedings

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