5774 REAL-WORLD EXPERIENCE WITH COVID-19 THERAPY IN KIDNEY TRANSPLANT PATIENTS DURING THE OMICRON VARIANT PERIOD

Abstract Background and Aims The development of new drugs against SARS-CoV-2 has improved the prognosis of COVID-19. Large studies often exclude transplant recipients or patients with chronic kidney disease, so the experience in kidney transplant (KT) patients is very limited. Method Retrospective cohort study of KT patients with mild-moderate COVID-19 in our area who were treated from 01/01/2022 to 12/31/2022. The indication to treat was made according to age, post-KT time and comorbidities. The type of drug depended on anti-spike serology and glomerular filtration rate. We did not use nirmatrelvir/ritonavir due to the risk of interactions. Results During the period of the study, 106 KT (55 women, 51 men) with mild-moderate COVID-19 were treated, with a mean age of 61 years and a KT vintage at the time of infection of 59 [29-186] months. Of them, 37.7% were diabetics and 83% were fully vaccinated prior to the infection. After the diagnosis, 63 (59.5%) patients received sotrovimab, 33 (31.1%) remdesivir, and 10 (9.4%) molnupiravir. The anti-spike antibody titer prior to the treatment was significantly lower in those patients who received sotrovimab (p = 0.000). The disease progressed requiring admission in 3 patients: 2 treated with sotrovimab and 1 with molnupiravir (admission rate: 3% [2/63] for sotrovimab and 10% [1/10] for molnupiravir). Any patient died. During the study period, 37 admissions due to COVID-19 in KT patients were registered in our area, of which 34 had not received any treatment (91.9%). Of these, 5 died, all of them being untreated patients before admission. The hospitalized patients did not show differences in age, post-RT time and vaccination status compared to the 106 treated with mild-moderate COVID-19. Conclusion Our results suggest that treatment of mild-moderate COVID-19 in high-risk KT patients may be effective in preventing progression to severe disease requiring admission. The highest rate of progression was observed in those treated with molnupiravir.