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BackgroundCoronavirus disease 2019 (COVID‐19) continues to negatively impact solid organ transplant recipients (SOTr). Data on the use of tixagevimab–cilgavimab (tix‐cil) in vaccinated SOTr during circulation of Omicron and its subvariants are limited. Therefore, this single‐center review was conducted to evaluate tix‐cil efficacy in multiple organ transplant groups during a study period where Omicron B.1.1.529, BA.2.12.1, and BA.5 predominated.MethodsIn this single‐center retrospective study, we evaluated the incidence of COVID‐19 infection in adult SOTr who did or did not receive pre‐exposure prophylaxis (PrEP) with tix‐cil. SOTr were included if they were at least 18 years of age and met emergency use authorization criteria for tix‐cil use. The primary outcome analyzed was the incidence of COVID‐19 infection.ResultsNinety SOTr met inclusion criteria and comprised of two groups, tix‐cil PrEP (n = 45) and no tix‐cil PrEP (n = 45). Of SOTr who received tix‐cil PrEP, three (6.7%) developed COVID‐19 infection, compared to eight (17.8%) in the no tix‐cil PrEP group (p = .20). Of the 11 SOTr diagnosed with COVID‐19, 15 (82.2%) were fully vaccinated against COVID‐19 prior to transplantation. Moreover, 18.2% and 81.8% of the COVID‐19 cases observed were asymptomatic and mild‐to‐moderate, respectively.DiscussionOur study results, which included months when BA.5 was in increased circulation, suggest no significant difference in COVID‐19 infection with or without use of tix‐cil PrEP in our solid organ transplant groups. As the COVID‐19 pandemic continues to evolve, clinical utility of tix‐cil should be evaluated against new, emerging strains. image