COVID-19 Vaccine Guidance for Patients with Organ Transplants

The reported cases of COVID-19 infection in the United States have greatly diminished as a result of increased rates of vaccinations. As a result, the U.S. Centers for Disease Control and Prevention (CDC)’s guidance for fully vaccinated people has become less stringent in recent months.

However, people with immunocompromised systems remain at higher risk for severe infection and hospitalization from the COVID-19 virus. Additionally, there are still many questions about the level of protection provided by COVID-19 vaccines and if this population can return to normal life along with the general public.

“We have seen that the antibody response to the COVID-19 vaccines among people with recent organ transplants is weaker than that of the general public,” says Camille Kotton, MD, clinical director of Transplant and Immunocompromised Host Infectious Diseases at Massachusetts General Hospital and a member of the CDC Advisory Committee on Immunization Practices. “That said, we are still seeing a slight response from the vaccines. So, the benefits of vaccination greatly outweigh any potential risks for transplant recipients.”

Dr. Kotton provides information about the effectiveness of the COVID-19 vaccines among transplant recipients and guidance for this patient population.

The Difference Between the Moderna, Pfizer and Johnson & Johnson Vaccines

The Pfizer and Moderna vaccines are mRNA vaccines, meaning they contain genetic material similar to the COVID-19 virus and are administered via two doses. The Johnson & Johnson vaccine is administered via one dose and contains non-live viral particles, similar to the makeup of the flu vaccine.

All currently available vaccines are recommended for patients with underlying medical conditions, which includes immunocompromising conditions like organ transplant.

The Level of Protection Among Transplant Recipients from the COVID-19 Vaccines

In general, it is typical for people with immunosuppressed systems to not get the same level of protection from vaccines. For transplant recipients, this reduced protection is associated with the immunosuppression medication that is taken following surgery, which works to suppress the immune system so that the body does not reject the donor organ.

Dr. Kotton and others at Mass General have been involved in local trials that study patients who recently underwent transplantation and their response to the SARS-CoV-2 mRNA-based vaccines, Moderna and Pfizer. In these trials, they observed the patient’s antibody, titers and cellular immune response.

Across all organ types, the team has determined a diminished antibody response following both doses when compared to the general public and that this result is dependent on many factors including:

• Age—Older patients tend to produce a weaker immune response following vaccination
• The type of immunosuppression medication—Some medications suppress the immune system more than others. Stronger medication is linked with a weaker antibody and cellular response to the COVID-19 vaccines
• The amount of time since transplantation—The most intense period of immunosuppression is the first three to six months after transplant and vaccinations are generally avoided during that time

Guidance for Transplant Patients

Continue to Take Your Prescribed Immunosuppression Medication

Many health care professionals are concerned that transplant patients will feel inclined to change their medication without consulting their doctors, or even stop it altogether.

“Do not do this. This will cause your body to reject your transplanted organ,” says Dr. Kotton. “Continue to take your same medication and consult with your care team along the way.”

Get Vaccinated as Soon as Possible

For people who are at least three months post-transplant, receiving the earliest available vaccine is critical. When possible, it is strongly recommended that patients get their vaccine prior to transplantation surgery and the start of immunosuppression, as this is the time frame that is believed to provide the highest level of protection.

“Vaccines are like a seatbelt in the car. Though it may not be 100% protection, you are much more likely to be saved in a bad accident,” says Dr. Kotton. “Even partial protection is better than none.”

Come In-Person for Necessary Care

Many transplant patients are continuing to feel reluctant to come to the hospital for care, even when they need it. In some cases, in-person visits are the best option to ensure a patient’s optimal health and wellbeing.

“For some transplant cases, virtual medicine can only go so far,” says Dr. Kotton. “Mass General is a safe place with low rates of disease in the community. We’re continuing to take the ultimate precautions to keep our community safe.”

Patients are advised to follow their doctor’s recommendation regarding in-person versus virtual visits.

What to expect when coming to Mass General for care

Continue to Take COVID-19 Safety Measures

Despite the updated guidelines from the CDC for fully vaccinated people, it is critical that transplant recipients continue to take all the COVID-19 safety measures to protect themselves against the virus, before and after vaccination. This includes wearing masks in public spaces—both indoor and outdoor—and practicing social distance.

CDC guidance for immunocompromised individuals

Creating a “Cocoon of Protection” for Transplant Patients

While those who are fully vaccinated may feel eager to return to normal life, it is recommended that family members and loved ones of transplant recipients continue to follow the recommended safety measures, such as masking and social distancing protocols, and get vaccinated as soon as possible.

“It’s standard for viruses like the flu that we not only vaccinate the transplant patient, but also everyone around them,” says Dr. Kotton. “We call it a ‘cocoon of protection’ and it’s no different for the COVID-19 virus.”

Particularly as society continues to re-open, vaccination is one of the strongest ways that the public can protect a loved one with an underlying condition.

Looking to the Future

While it’s clear that transplant recipients receive less protection from the vaccines, many questions remain unanswered and are the focus in numerous research studies.

“We’re working to uncover answers to many questions. Should we give booster doses, or a third dose, to transplant patients?” says Dr. Kotton. “Should we take a multiple vaccine approach, such as giving the Johnson & Johnson vaccine to someone who already had an mRNA vaccine? Or, are there other vaccines, either currently available or under development, that provide better protection?”

There is research underway, both at Mass General and beyond, to uncover the answers to these questions in order to provide people with immunocompromised systems the greatest level of protection against COVID-19.