#4960 TIXAGEVIMAB AND CILGAVIMAB (EVUSHELD) FOR PRE-EXPOSURE PROPHYLAXIS OF COVID-19: A MONOCENTRIC STUDY IN KIDNEY TRANSPLANT RECIPIENTS

Abstract

Abstract Background and Aims Patients, who underwent kidney transplantation, may be at particularly high risk of mortality due to immunosuppressive therapy and underlying comorbidity such as hypertension, cardiovascular disease and diabetes mellitus finally increasing the risk of a severe form of SARS-CoV-2 infection. According to the ERA-EDTA DESCARTES expert opinion, management of immunosuppression in SARS-CoV-2 infection suggests withdrawal of antimetabolite (mycophenolate or azathioprine) in patients with mild upper respiratory and/or gastrointestinal symptoms and discontinuation of all immunosuppressive drugs with maintenance of steroid for severe bilateral pneumonia. Despite SARS-CoV-2 vaccination, kidney transplant patients remain at increased risk for severe COVID-19 infection and mortality and at high priority for additional strategies for preexposure prophylaxis.Tixagevimab and cilgavimab are long-acting monoclonal antibodies against the spike protein of SARS-CoV-2, which block the virus’ attachment and entry into human cells. This combined monoclonal antibody (Evusheld®) has been granted emergency use authorization (EUA) by the U. S food and drug administration (FDA) for individuals 12 years and older who have a moderate to severe immunocompromising condition and may not mount an adequate vaccination response.This single cohort observational study reports the incidence and outcomes of COVID-19 among kidney transplant recipients receiving Evusheld® as preexposure prophylaxis. Method Observational monocentric cohort study of 119 kidney transplant patients receiving Evusheld® 150/150 mg intramuscularly as preexposure prophylaxis between July 1, 2022 and December 31, 2022. Inclusion criteria: kidney or combined kidney-pancreas transplantation within 1 year; recent acute allograft rejection; time since COVID-19 infection of 120 days and time since last vaccine dose of 2 weeks. Results After a median (range) follow-up of 150 days, COVID-19 was confirmed in 48/119 patients (40.3%), who had only a light form of COVID-19 infection. No one complained side. Conclusion Our study reported a low rate of infections with only light symptoms among kidney transplant patients treated with Evusheld®. A long-term study with a larger cohort might better evaluate the efficacy, outcomes and safety of this preexposure prophylaxis.