background and objectives: underpowered immune response to vaccines against SARS-CoV-2 was observed in solid organ transplant (SOT) recipients. a novel combination of monoclonal antibodies tixagevimab-cilgavimab (TGM/CGM) received authorization as pre-exposure prophylaxis (PrEP) in those with reduced response to vaccine. we aimed to evaluate the response rate to COVID-19 vaccination in kidney transplant (KT), compared to liver transplant (LT) recipients, and the efficacy and safety of PrEP with TGM/CGM. material and methods: between march and november 2022, adult KT and LT recipients who had completed the vaccination schedule (3 doses) were tested for anti-SARS-CoV-2 antibodies titer. SOT recipients with anti-SARS-CoV-2 titer >= 100 IU/mL were considered protected against infection, while those with titer < 100 UI/mL were defined non-protected. patients with inadequate response were invited to PrEP. results: In total, 306 patients were enrolled [KT:197 (64.4%), LT:109 (35.6%)]. After the complete scheme of vaccination, 246 (80.3%) patients developed a protective titer, while 60 (19.6%) did not have a protective titer. KT recipients had a lower rate of protective anti-COVID-19 titer compared to LT patients [149 (75.6%) vs. 97 (89.0%), p = 0.004]. recipients with non-protective anti-COVID-19 titer received mainly tacrolimus-based regimen associated with mycophenolate mofetil (MMF) (70%) e steroids (46.7%) as maintenance immunosuppression, while those treated with everolimus were associated with higher protective titer. Of 35 (58.3%) patients who received PrEP, within 12 months, 6 (17.1%) (all KT) developed pauci-symptomatic COVID-19 disease, while 15/25 (60%) of non-responders, who did not receive the prophylaxis, developed COVID-19 disease. after PrEP, hospitalization rate was lower (2.8% vs. 16%), and no adverse events, neither graft loss nor rejection, were observed. conclusions: despite complete COVID-19 vaccination, SOT recipients might be not protected from the SARS-CoV-2 infection, especially after KT. In non-protected SOT patients, the subsequent pre-exposure prophylaxis with combination of monoclonal antibodies (TGM/CGM) might be an efficacy and safe strategy to prevent COVID-19 severe disease and hospitalization.

Angelico, R., Romano, F., Coppola, L., Materazzo, M., Pedini, D., Santicchia, M.s., et al. (2023). Effects of Anti-COVID-19 Vaccination and Pre-Exposure Prophylaxis with Tixagevimab-Cilgavimab in Kidney and Liver Transplant Recipients. MEDICINA, 59(12) [10.3390/medicina59122101].

Effects of Anti-COVID-19 Vaccination and Pre-Exposure Prophylaxis with Tixagevimab-Cilgavimab in Kidney and Liver Transplant Recipients

Roberta Angelico;Francesca Romano;LUIGI COPPOLA;Marco Materazzo;Domiziana Pedini;Maria Sara Santicchia;Roberto Cacciola;Luca Toti;Loredana Sarmati;Giuseppe Tisone
2023-01-01

Abstract

background and objectives: underpowered immune response to vaccines against SARS-CoV-2 was observed in solid organ transplant (SOT) recipients. a novel combination of monoclonal antibodies tixagevimab-cilgavimab (TGM/CGM) received authorization as pre-exposure prophylaxis (PrEP) in those with reduced response to vaccine. we aimed to evaluate the response rate to COVID-19 vaccination in kidney transplant (KT), compared to liver transplant (LT) recipients, and the efficacy and safety of PrEP with TGM/CGM. material and methods: between march and november 2022, adult KT and LT recipients who had completed the vaccination schedule (3 doses) were tested for anti-SARS-CoV-2 antibodies titer. SOT recipients with anti-SARS-CoV-2 titer >= 100 IU/mL were considered protected against infection, while those with titer < 100 UI/mL were defined non-protected. patients with inadequate response were invited to PrEP. results: In total, 306 patients were enrolled [KT:197 (64.4%), LT:109 (35.6%)]. After the complete scheme of vaccination, 246 (80.3%) patients developed a protective titer, while 60 (19.6%) did not have a protective titer. KT recipients had a lower rate of protective anti-COVID-19 titer compared to LT patients [149 (75.6%) vs. 97 (89.0%), p = 0.004]. recipients with non-protective anti-COVID-19 titer received mainly tacrolimus-based regimen associated with mycophenolate mofetil (MMF) (70%) e steroids (46.7%) as maintenance immunosuppression, while those treated with everolimus were associated with higher protective titer. Of 35 (58.3%) patients who received PrEP, within 12 months, 6 (17.1%) (all KT) developed pauci-symptomatic COVID-19 disease, while 15/25 (60%) of non-responders, who did not receive the prophylaxis, developed COVID-19 disease. after PrEP, hospitalization rate was lower (2.8% vs. 16%), and no adverse events, neither graft loss nor rejection, were observed. conclusions: despite complete COVID-19 vaccination, SOT recipients might be not protected from the SARS-CoV-2 infection, especially after KT. In non-protected SOT patients, the subsequent pre-exposure prophylaxis with combination of monoclonal antibodies (TGM/CGM) might be an efficacy and safe strategy to prevent COVID-19 severe disease and hospitalization.
2023
Pubblicato
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MEDS-06/A - Chirurgia generale
English
SARS-CoV-2
anti-SARS-CoV-2 antibodies' titer
COVID-19 disease
pre-exposure prophylaxis
long-active antibody
tixagevimab
cilgavimab
solid organ transplantation
kidney transplantation
liver transplantation
immunosuppression
Angelico, R., Romano, F., Coppola, L., Materazzo, M., Pedini, D., Santicchia, M.s., et al. (2023). Effects of Anti-COVID-19 Vaccination and Pre-Exposure Prophylaxis with Tixagevimab-Cilgavimab in Kidney and Liver Transplant Recipients. MEDICINA, 59(12) [10.3390/medicina59122101].
Angelico, R; Romano, F; Coppola, L; Materazzo, M; Pedini, D; Santicchia, Ms; Cacciola, R; Toti, L; Sarmati, L; Tisone, G
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/388905
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