EVUSHELD IN LIVER AND KIDNEY TRANSPLANT PATIENTS , WAS IT WORTH IT?

Document Type

Conference Proceeding

Publication Date

10-25-2023

Publication Title

Hepatology

Abstract

Background: Immunosuppression in patients with solid organ transplant has raised significant concerns regarding outcomes of COVID-19 infection. Pre-exposure use of monoclonal antibodies, specific to certain viral strains as an adjunct to vaccination has been proposed to enhance the immune response following the vaccine. In this study, we aimed to assess the efficacy of the emergency use of Evusheld in this sub-population. Methods: This was a retrospective chart review study conducted at a tertiary care center during the time period of 2022 , 2023 during which adult patients (age >18 y old) with liver, kidney or simultaneous Liver- Kidney transplant who received Evusheld were included. Patients' demographics, disease characteristics, and outcomes were recorded in de-identified datasheets. The primary outcome was incidence of COVID-19 positive PCR test. Secondary outcomes included: progression to Interstitial lung disease (ILD), rate of hospitalization. The Wilcoxon rank sum test, Pearson's Chi-squared test, Fisher's exact test and Wilcoxon rank sum exact test were used for univariate analyses. Results: Among 1149 who received solid organ transplant, 273 (23.7%) patients were diagnosed with COVID-19 from the advent of the pandemic, to February 2023. Patients infected with COVID-19 were more likely to be younger (mean age 61.6 ± 10.9 y versus 63.4 ± 11.5 y, p =0.007), of white race (25.6% versus black 15.2 % and others 14.7 %, p= 0.014). In the total population 26% (296) received Evusheld. Among those who received Evusheld the incidence of covid was 13% (37/296) compared to 28% (236/853) in the patients who did not receive the Evusheld, p< 0.01. Data for post covid ILD was available in only 43.7% (118) patients. Among those with data available, prevalence of post covid ILD was 0%(0/22) and 8.1% (8/96) among those who did and did not receive evusheld respectively, p-value 0.045. Among those with data available, 16.1% (5/31) patients were hospitalized after getting Evusheld as compared to 20.7% (46/176) in patients who did not receive evusheld, p =0.689. Conclusion: Our data shows that Evusheild may have reduced incidence of COVID-19 and provided significant protection against post infectious ILD. It also showed that incidence of COVID-19 in post-transplant patients may be much higher than previously reported. Currently, the FDA has halted all use of Evusheild due to the combined frequency of non-susceptible SARSCoV- 2 variants nationally being more than 90%. However, they do recommend keeping the unexpired batches safe for future, in case new variants show susceptibility.

Volume

78

First Page

S310

Last Page

S311

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