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BACKGROUND: Solid organ transplant (SOT) recipients are at high risk for complications from coronavirus disease 2019 (COVID-19) and vaccine breakthrough infections are common. We determined the effectiveness of ≥3 doses of mRNA vaccine and early monoclonal antibody therapy in reducing disease severity against the Omicron (B. 1. 1. 529) variant. METHODS: Prospective cohort study of consecutive SOT recipients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection referred to our transplant center who were followed for at least 30 days. The primary outcome was supplemental oxygen requirement. Effectiveness of sotrovimab and ≥3 vaccine doses was estimated using adjusted risk ratios (RR). RESULTS: Three hundred adult organ transplant recipients were included. Seventy-one patients (24. 1%) were hospitalized, 44 (14. 9%) required supplemental oxygen, 19 (6. 5%) were admitted to the intensive care unit (ICU), 15 (5. 1%) required mechanical ventilation (MV), and 13 (4. 4%) died. On multivariate analysis, age and multiple comorbidities were risk factors for oxygen requirement. Both receipt of ≥3 vaccine doses prior to SARS-CoV-2 infection and receipt of sotrovimab in the first 7 days of symptom onset was associated with a reduction in the need for supplemental oxygen (RR 0. 30 95% confidence interval CI: . 17 to. 54 and RR 0. 24 (95% CI: . 1 to. 59), respectively]. For sotrovimab, the number needed to treat (NNT) to prevent one patient requiring oxygen was 6. 64 (95% CI: 4. 56-13. 66). Both sotrovimab use and having received ≥3 vaccine doses were also associated with a shorter hospitalization length of stay. CONCLUSIONS: In a cohort of SOT recipients with Omicron variant COVID-19 infection, prior receipt of ≥3 mRNA vaccine doses and early monoclonal antibody therapy were independently associated with significantly reduced disease severity.
Solera et al. (Tue,) studied this question.