D0523 - The Role of Immunosuppressants, Vaccination, and Monoclonal Antibody Treatment in COVID-19 Outcomes for Liver and Renal Transplant Recipients

Tuesday, October 25, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Ashley Francis, BS

Wayne State University School of Medicine
Detroit, MI

Ashley Francis, BS¹, Ahmed Elbanna, DO², Omar Shamaa, MD², Suraj Suresh, MD³, Sara Farooqui, BS⁴, Talan Zhang, MPH, MS², Mei Lu, PhD², Syed-Mohammed Jafri, MD²
¹Wayne State University School of Medicine, Detroit, MI; ²Henry Ford Health System, Detroit, MI; ³Henry Ford Hospital, Northville, MI; ⁴Wayne State University School of Medicine, Bloomfield Hills, MI

Introduction: Post-transplant immunosuppression may leave solid organ transplant (SOT) recipients at an increased risk of SARS-CoV-2 infection and related morbidity. The effectiveness of vaccination and monoclonal antibody (MAB) treatments remains unclear for this population. We aim to describe how these factors affect outcomes for liver and renal transplant (LRT) recipients infected with SARS-CoV-2.

Methods: A retrospective study of LRT recipients diagnosed with COVID-19 between 3/2020 to 1/2022 was performed. We recorded data on patient demographics, immunosuppressants, vaccine dose numbers, MAB treatment, hospitalization, length of stay (LOS, days), mechanical ventilation (MV) use, as well as 3- and 6-month mortality. Quantitative and qualitative (positive (+) or negative (-)) IgG antibodies were recorded when present. Statistical analysis included Chi Square tests, t-tests and logistic regression.

Results: Demographics of 255 LRT recipients diagnosed with COVID-19 are shown in Table 1. 68 (26%) liver, 177 (69%) renal, and 10 (4%) dual LRT patients were identified. First, the number of immunosuppressants taken at the time of diagnosis was found to be correlated with the LOS, with an increase of 1.5 days for each addition (p=0.029). However, there was no statistically significant correlation found between number of vaccine doses (up to 3) and hospitalization rates (p=0.948), LOS (p=0.688), 3-month mortality (p=0.549), or 6-month mortality (p=0.595). 65 (25%) patients were treated with MABs; these had fewer hospitalizations (37% vs 68% p< 0.001) and a trend towards reduced mortality at 3 months (11% vs 18% p=0.177) and 6 months (11% vs 20% p=0.092). There was no significant difference in MV (25% vs 20% p=0.589) or LOS (7.92 ± 6.20 vs 8.78 ± 8.51 p=0.820). We also analyzed 22 patients with 13 (+) and 9 (-) IgG levels recorded post-vaccination (median 42 days and 88 days, resp.). There was no significant difference in vaccine dosages between (+) and (-) IgGs (p=0.881), or an association between (+)/(-) IgG level and hospitalizations (p=0.338).

Discussion: The immunosuppressed state of LRT recipients negatively impacts recovery from COVID-19. Our data demonstrates that MAB treatment significantly reduces hospitalizations and 3- and 6-month mortality. Additionally, the inability to predict any improvement in clinical outcomes offered by a 3-vaccine series suggests the need to consider further therapeutic options such as a fourth mRNA vaccine dose and the use of tixagevimab/cilgavimab for SOT recipients.

Variable	Response	Number of Vaccine Doses Before COVID-19 Diagnosis
		All	0	1	2	3
		(N=255)	(N=161)	(N=16)	(N=56)	(N=22)
Age	Mean (SD), y	57.6 (13.56)	57.1 (13.07)	56.2 (13.37)	57.8 (15.28)	61.5 (12.75)
Age	Median, y	59	58	57	61.5	64.5
Gender	F, n (%)	108 (42)	66 (41)	4 (25)	27 (48)	11 (50)
Gender	M, n (%)	147 (58)	95 (59)	12 (75)	29 (52)	11 (50)
Race	White, n (%)	141 (55)	88 (55)	9 (56)	34 (61)	10 (45)
	Black, n (%)	104 (41)	65 (40)	7 (44)	22 (39)	10 (45)
	Hispanic, n (%)	6 (2)	6 (4)	0 (0)	0 (0)	0 (0)
	Asian, n (%)	4 (2)	2 (1)	0 (0)	0 (0)	2 (9)

Table: Table 1: Demographic Data of LRT Recipients Stratified by Number of Vaccine Doses Before COVID-19 Diagnosis

*y: years

Disclosures:

Ashley Francis indicated no relevant financial relationships.

Ahmed Elbanna indicated no relevant financial relationships.

Omar Shamaa indicated no relevant financial relationships.

Suraj Suresh indicated no relevant financial relationships.

Sara Farooqui indicated no relevant financial relationships.

Talan Zhang indicated no relevant financial relationships.

Mei Lu indicated no relevant financial relationships.

Syed-Mohammed Jafri indicated no relevant financial relationships.

Ashley Francis, BS¹, Ahmed Elbanna, DO², Omar Shamaa, MD², Suraj Suresh, MD³, Sara Farooqui, BS⁴, Talan Zhang, MPH, MS², Mei Lu, PhD², Syed-Mohammed Jafri, MD². D0523 - The Role of Immunosuppressants, Vaccination, and Monoclonal Antibody Treatment in COVID-19 Outcomes for Liver and Renal Transplant Recipients, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.