Purpose
Lung transplant (LTx) recipients are at risk for poor outcomes from coronavirus disease 2019 (COVID-19). The aim of the study was to assess the outcome of patients receiving pre-exposure prophylaxis (PrEP) with tixagevimab and cilgavimab after LTx.
Methods
All LTx recipients with outpatient visits from February 28th to October 31st, 2022 at two German centers were included. Baseline characteristics were recorded and patients followed until November 30rd, 2022. Infections with SARS-CoV-2, disease severity, and COVID-19-associated death were compared between patients with and without PrEP.
Results
In total, 1438 patients were included in the analysis, and 419 (29%) received PrEP. Patients receiving PrEP were older and earlier after transplantation, had lower glomerular filtration rates, and lower levels of SARS-CoV-2-S antibodies. In total, 535 patients (37%) developed SARS-CoV-2 infection during a follow-up of median of 209 days. Fewer infections occurred in patients with PrEP during the study period (31% vs. 40%, p = 0.004). Breakthrough SARS-CoV-2 infections after PrEP occurred in 77 patients (19%). In total, 37 infections (8%) were severe or critical. No difference in severity of COVID-19 was observed between patients with and without PrEP. There were 15 COVID-19-associated deaths (n = 1 after PrEP). Compared to matched controls, there was a non-significant difference towards a lower risk for moderate to critical COVID-19 (p 0.184).
Conclusion
The number of SARS-CoV-2 infections was lower in LTx recipients with PrEP. Despite being at higher risk for worse outcome severity of COVID-19 and associated mortality were similar in patients with and without PrEP.
ZUSAMMENFASSUNGKomplikationen einer Leberzirrhose haben eine schlechte Prognose. Doch während das Risiko, an einer hepatischen Enzephalopathie oder einer Ösophagusvarizenblutung zu sterben, kontinuierlich abgenommen hat, ist das Risiko, an einer Sepsis zu sterben, immer größer geworden. Aus verschiedenen Gründen ist es sinnvoll, das Akut-auf-chronische Leberversagen mit seinem charakteristischen Hyperinflammationssyndrom als eigene klinische Entität abseits der traditionellen dekompensierten Zirrhose zu definieren. Der folgende Artikel führt in das Krankheitsbild ein und stellt die Auslöser, die systemischen Folgen und die komplexe Therapie praxisorientiert dar.
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