Monoclonal Antibody Therapy for COVID-19 in Solid Organ Transplant Recipients

Zachary A. Yetmar, Elena Beam, John C. O'Horo, Ravindra Ganesh, Dennis M. Bierle, Lisa Brumble, Maria Teresa Seville, Raymund R. Razonable

Research output: Contribution to journalArticlepeer-review


Background:Bamlanivimab and casirivimab-imdevimab are authorized for emergency use treatment of mild to moderate coronavirus disease 2019 (COVID-19) in patients at high risk for developing severe disease or hospitalization. Their safety and efficacy have not been specifically evaluated in solid organ transplant recipients. Methods:We retrospectively reviewed solid organ transplant recipients who received monoclonal antibody infusion for COVID-19 at Mayo Clinic sites through January 23, 2021. Outcomes included emergency department visit, hospitalization, mortality, and allograft rejection. Results:Seventy-three patients were treated, most commonly with bamlanivimab (75.3%). The median age was 59 years, 63% were male, and the median Charlson comorbidity index was 5. Transplant type included 41 kidney (56.2%), 13 liver (17.8%), 11 heart (15.1%), 4 kidney-pancreas (5.5%), 2 lung (2.7%), 1 heart-liver, and 1 pancreas. Eleven (15.1%) patients had an emergency department visit within 28 days of infusion, including 9 (12.3%) who were hospitalized for a median of 4 days. One patient required intensive care unit admission for a nonrespiratory complication. No patients required mechanical ventilation, died, or experienced rejection. Ten adverse events occurred, with 1 seeking medical evaluation. Hypertension was associated with hospital admission (P<.05), while other baseline characteristics were similar. The median time from symptom onset to antibody administration was 4 days in nonhospitalized patients compared with 6 days among hospitalized patients (P<.05). Conclusions:Monoclonal antibody treatment has favorable outcomes with minimal adverse effects in solid organ transplant recipients with mild to moderate COVID-19. Earlier administration of monoclonal antibody therapy appears to be more efficacious.

Original languageEnglish (US)
Article numberofab255
JournalOpen Forum Infectious Diseases
Issue number6
StatePublished - Jun 1 2021


  • COVID-19
  • SARS-CoV-2
  • bamlanivimab
  • casirivimab-imdevimab
  • transplant

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology


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