Bamlanivimab for Mild to Moderate COVID-19 in Kidney Transplant Recipients

Abstract

Kidney transplant recipients (KTRs) are at an increased risk of hospitalization, complications, and mortality from COVID-19 compared with the general population.1, 2, 3, 4, 5 Among KTRs with COVID-19 in the United States, studies have shown hospitalization rates ranging from 32% to 100%,1,3, 4, 5, 6 intensive care unit (ICU) admission rates from 20% to 61%,2,4 and overall mortality of 13% to 39%.1,2,4, 5, 6 A high incidence of acute kidney injury was noted, ranging from 30% to 89%,2,4, 5, 6 while renal replacement therapy was required in 13% to 21% of patients.1,7 Given the natural history of COVID-19 pneumonia, most of these complications occurred ≥1 week after the diagnosis of COVID-19. Given the high impact of COVID-19 infection on KTRs, early COVID-19–directed therapies are critical. Bamlanivimab (LY-CoV555) was given Emergency Use Authorization (EUA) by the US Food and Drug Administration on November 9, 2020.8 It is a neutralizing IgG1 monoclonal antibody that binds to the receptor-binding domain of the spike protein of SARS-CoV-2, inhibiting attachment to human angiotensin-converting enzyme 2 receptor. This EUA was given for treatment of mild to moderate COVID-19 in patients ≥12 years of age weighing >40 kg who are positive with a direct viral testing for SARS-CoV-2 and have high risk for progressing to severe COVID-19 and/or hospitalization.8 KTRs with COVID-19 are considered high risk because of immunosuppressive medication use.9 Studies on the use of bamlanivimab among KTRs are limited. To provide more insight on the use of bamlanivimab in KTRs we report our experience with 24 KTRs.