Mortality in individuals treated with COVID-19 convalescent plasma varies with the geographic provenance of donors

Nat Commun. 2021 Aug 11;12(1):4864. doi: 10.1038/s41467-021-25113-5.


Successful therapeutics and vaccines for coronavirus disease 2019 (COVID-19) have harnessed the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Evidence that SARS-CoV-2 exists as locally evolving variants suggests that immunological differences may impact the effectiveness of antibody-based treatments such as convalescent plasma and vaccines. Considering that near-sourced convalescent plasma likely reflects the antigenic composition of local viral strains, we hypothesize that convalescent plasma has a higher efficacy, as defined by death within 30 days of transfusion, when the convalescent plasma donor and treated patient were in close geographic proximity. Results of a series of modeling techniques applied to approximately 28,000 patients from the Expanded Access to Convalescent Plasma program ( number: NCT04338360) support this hypothesis. This work has implications for the interpretation of clinical studies, the ability to develop effective COVID-19 treatments, and, potentially, for the effectiveness of COVID-19 vaccines as additional locally-evolving variants continue to emerge.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Antibodies, Viral / immunology
  • Antibody Specificity
  • Antigenic Variation
  • Blood Donors
  • COVID-19 / mortality
  • COVID-19 / therapy*
  • Female
  • Humans
  • Immunization, Passive / mortality
  • Male
  • Middle Aged
  • Plasma / immunology*
  • SARS-CoV-2 / genetics
  • SARS-CoV-2 / immunology
  • Treatment Outcome
  • United States / epidemiology
  • Young Adult


  • Antibodies, Viral

Supplementary concepts

  • COVID-19 serotherapy

Associated data