VACCINATION, MONOCLONAL ANTIBODY AND MYCOPHENOLATE EFFECTS ON CLINICAL OUTCOMES IN LIVER VERSUS KIDNEY TRANSPLANT RECIPIENTS WITH COVID-19 INFECTION

Document Type

Conference Proceeding

Publication Date

10-25-2023

Publication Title

Hepatology

Abstract

Background: We aim to evaluate how vaccination, monoclonal antibody (MAB) treatment, and mycophenolate use correlate to 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. Results: Of 255 LRT recipients diagnosed with COVID-19, 68 (26%) liver, 177 (69%) renal, and 10 (4%) dual LRT patients were identified. When comparing liver transplant to renal transplant patients, there was no significant difference in hospitalization and mortality. Overall, no significant correlation was 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). However, when comparing 12 liver transplant to 51 renal transplant recipients treated with MABs, there was no significant difference in hospitalization or mortality at 3 or 6 months. Mycophenolate use in 199 patients was associated with increased hospitalization (62% vs 55% p= 0.383), MV (24% vs 10% p= 0.135), and mortality at 3 and 6 months respectively when compared to non-users (18% vs 9% p =0.099 and 20% vs 11% p = 0.123). Of 78 liver transplant patients, 53 (68%) were on mycophenolate. Similarly, within this group, mycophenolate use was associated with increased hospitalization rates (58% vs 44% p= 0.231), and mortality at 3 and 6 months respectively when compared to non-users (19% vs 0% p =0.020 and 11% vs 0% p = 0.014, respectively). Of 187 renal transplant patients, 152 (81%) were on mycophenolate. Within this group, there was no difference in hospitalization rates among users and non-users (62% vs 62%). When comparing 47 liver to 146 renal transplant patients on mycophenolate (excluding dual LRT patients), there was no significant difference in hospitalization (p = 0.672) or mortality at 3 months (p =0.595) or 6 months (p = 0.530). Conclusion: Our data demonstrates that MAB treatment significantly reduces hospitalizations and 3- and 6-month mortality, irrespective of the type of transplant. Mycophenolate was associated with increased hospitalizations and mortality rates, with common trends seen in liver transplant patients alone. Our data further suggests that a 3- vaccine series was inadequate to predict improvements in clinical outcomes for LRT recipients, suggesting further study of a fourth mRNA vaccine dose and the use of tixagevimab/cilgavimab.

Volume

78

First Page

S352

Last Page

S353

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