(701) Use of Tixagevimab and Cilgavimab (Evusheld) and Subsequent Outcomes of SARS-CoV-2 Infections in Lung Transplant Recipients

PURPOSE: The protection of solid organ transplant recipients from infection has been challenging throughout the Coronavirus disease (COVID-19) pandemic. In 2022, tixagevimab and cilgavimab (Evusheld) was introduced as a means of providing passive antibodies and augmenting the vaccine immune response in immunocompromised patients. We aimed to assess the efficacy of Evusheld in reducing the incidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in lung transplant recipients. METHODS: We conducted a single center, retrospective, observational cohort study examining SARS-CoV-2 incidence in 289 lung transplant recipients from January 2022 through July 2022. Manual chart extraction was utilized to collect dates of Evusheld administration, SARS-CoV-2 vaccination, and SARS-CoV-2 infection, as well as demographic and clinical data. Exact logistic regression models were used to compare incidence of SARS-CoV-2 infection and hospitalization rates between lung transplant recipients who received versus did not receive Evusheld. RESULTS: Of the 289 lung transplant recipients, 136 (47.1%) received Evusheld during the study period. The incidence of SARS-CoV-2 infection in transplant recipients who received Evusheld was 8.1% (or 11/136), compared to 34.0% (or 52/153) among those who did not receive Evusheld. Controlling for the number of SARS-CoV-2 vaccines received, the odds of a SARS-CoV-2 infection was approximately 83% lower for patients who received Evusheld (OR=0.18, 95% CI: 0.08 to 0.38, p<0.001). Further, the rate of hospitalization was available for 62 of 63 (98.4%) patients with a SARS-CoV-2 infection. Among these patients, no patient in the Evusheld group required hospitalization; conversely, 12 of 51 (23.5%) patients who did not receive Evusheld required hospitalization (OR=0.39, 95% CI: 0.00 to 2.38, p=0.21). CONCLUSION: Evusheld administration was associated with significant efficacy in the prevention of SARS-CoV-2 infection in lung transplant recipients.