Anti-Cytomegalovirus Hyperimmune Immunoglobulins as Adjunctive Therapy during Acute COVID-19 in Kidney Transplant Recipients: A Single-Center Retrospective Cohort Study.

Introduction. Anti-CMV immunoglobulin (CMV-HIG) contains antibodies against various infective pathogens and not only against the cytomegalovirus (CMV), thus possibly mimicking the convalescent plasma. Methods. A retrospective analysis concerning the practice of CMV-HIG off-label use during acute COVID- 19 in kidney transplant recipients (KTR). Results. From March 2020 to August 2022, 403 KTR (59.8% male) who developed COVID-19 were eligible for investigation. 151(44.4%) patients required hospitalization, and eighteen (5,6%) mechanical ventilation. Thirty-four (8.4%) patients received CMVHIG. Two patients had CMV reactivation and received CMVHIG 2 ml/kg in five doses. Others had hypogammaglobulinemia which was an additional off-label indication for using CMVHIG during acute COVID-19. 22 patients (6.5%) died, 4 of them from the CMVHIG group. Conclusion. A correction of hypogammaglobulinemia, potential remodeling of the immunological response, and CMV reactivation during acute infection, may justify the use of CMVHIG during acute COVID-19. [ABSTRACT FROM AUTHOR]