Keck Hospital of USC performs some 300 liver and kidney transplants each year, and provides ongoing care to thousands of post-transplant patients on an outpatient basis. During the peak of the COVID-19 surge in Los Angeles, Keck Medicine of USC physicians implemented a new protocol to monitor and manage the care of liver and kidney transplant recipients who developed COVID-19, including monoclonal antibody therapy for eligible patients.
Now, a new study published by Keck, shows that as a result of these efforts, the number of hospitalizations and deaths for patients managed with the new protocol dropped by 18%. For those who received the drug therapy, the number of hospitalizations were halved, and deaths reduced to zero.
“We took a very proactive approach in managing our at-risk patients that resulted in significantly improved outcomes,” said Aaron Ahearn, MD, PhD, a liver, kidney and pancreas transplant surgeon with Keck Medicine, who also is the principal investigator and corresponding author of the study.
Early in the pandemic, Keck Medicine physicians realized that COVID-19 was much more lethal for transplant recipients than the general population. By December 2020, the height of the Los Angeles outbreak, they were treating 20 or more COVID-positive liver or kidney transplant recipients per week, many of them gravely ill.
Ahearn and his colleagues assembled a multidisciplinary team consisting of transplant, infectious disease, nephrology, hepatology and family medicine specialists to devise a new patient protocol that included:
• Creating a database to track COVID-19 outcomes.
• Educating staff on identifying and monitoring COVID-19 symptoms.
• Creating a triage system to determine the severity of the disease and appropriate level of care.
• Providing telehealth visits by internal and family medicine doctors.
• Giving all recent transplant recipients a home pulse oximetry monitor to track their oxygen levels.
Additionally, eligible patients who tested positive for COVID-19 were offered monoclonal antibody therapy, which the U.S. Food and Drug Administration had approved in November 2020 for emergency use to treat COVID-19. Monoclonal antibodies have been found to be effective for treating mild to moderate COVID-19 disease soon after infection.
Patients who tested positive for COVID-19 within the previous 10 days with symptoms not severe enough to be hospitalized were eligible for the drug therapy. All patients who met this criterion were offered a single outpatient infusion of one of two monoclonal antibody therapies.
For the study, the physicians conducted a retrospective review of all liver and kidney transplant recipients who tested positive for COVID-19 and were seen at Keck Hospital from Feb. 1, 2020 to Feb. 28, 2021, a total of 226 patients. They reviewed patient demographics, COVID-19 treatments, hospitalizations and survival rates.
When comparing the outcomes of all patients before and after the protocol was implemented, the study authors found the total rate of hospitalization dropped from 54% to 35% and deaths from 20% to 9%.
They also discovered that the protocol was even more effective for patients who were identified early in their disease course and were therefore eligible for monoclonal antibody therapy.
A total of 34 (17 liver or combined liver/kidney transplant recipients and 17 kidney transplant recipients) received the drug therapy. For this group, COVID-related hospitalizations fell from 32% to 15% and death from 13% to zero.
Additionally, none of the patients had a major adverse reaction to the therapies.
Ahearn believes these results have important implications for the continued treatment of liver and kidney transplant recipients in the age of COVID-19.