COVID-19 Information for Transplant Patients
For Advanced Organ Therapies and Transplant Patients
The CDC recommends an additional dose for immunocompromised people ages 5 and older who received an mRNA vaccine from Pfizer or Moderna. (Pfizer remains the only vaccine approved for ages 5-17.) The additional dose is recommended 28 days or more after the second dose.
A booster dose is also recommended for those who are immunocompromised with the following guidance:
- Ages 12 – 17: A booster dose of the Pfizer COVID-19 vaccine is recommended 5 months or more after receiving additional dose.
- Ages 18 and older who completed the Pfizer or Moderna vaccine series: A booster dose of the Pfizer or Moderna COVID-19 vaccine is recommended 5 months or more after receiving additional dose.
- Ages 18 and older who received the J&J primary vaccine: A booster dose of the Pfizer or Moderna COVID-19 vaccine is recommended 28 days after receiving the primary J&J dose.
- Ages 50 and older: A second mRNA booster dose is recommended 4 months after the first booster.
Frequently Asked Questions
COVID-19 Vaccine and Transplant Patients
The currently approved vaccines are not made from live or inactivated viruses and are safe in transplant recipients. Due to the safety of the vaccines and the risk of severe COVID-19 disease in immunocompromised patients, we strongly recommend that all transplant recipients undergo vaccination.
Transplant recipients have a reduced antibody response to the vaccine compared to those without transplants but receive some protection against more severe COVID-19 disease via alternate immune mechanisms. Therefore, it is still possible to receive protection from the COVID-19 vaccines in the absence of a strong antibody response. Furthermore, current data suggest that administration of a third dose of vaccine in transplant patients who have previously received two doses of mRNA vaccine (Pfizer or Moderna) can significantly increase your immune response to SARS-CoV-2. The American Society of Transplantation and the International Society of Heart and Lung Transplantation have provided guidance and recommend vaccination in transplant candidates and recipients.
We recommend that all transplant candidates get vaccinated as soon as possible. The ideal time to complete your primary vaccination series is at least two weeks prior to your transplant surgery.
If you’ve received an organ transplant in the past, we recommend vaccination starting at 3 months after your transplant surgery.
Additional Dose: The CDC currently recommends that certain individuals with moderately to severely compromised immune systems get an additional dose of their primary COVID-19 vaccine. The CDC recommendation varies based on an individual’s age and the vaccine type.
Additional Dose Recommendations
Recommended Ages Pfizer Moderna Janssen/J&J
Age less than 5 years
No No No Ages 5 to 17 Yes – 28 days after the second dose No No Age 18 and older Yes – 28 days after the second dose Yes – 28 days after the second dose Yes – 28 days after the second dose
Booster Dose: For those 12 years and older, including immunocompromised people, the CDC recommends a booster dose. If you're eligible for an additional dose, you should get this dose first before you get a booster shot.
Booster Dose Recommendations
Recommended Ages Pfizer Moderna Janssen/J&J
Age less than 12 years
No No No
Ages 12 to 17
Yes – a first booster dose of the Pfizer-BioNTech COVID-19 vaccine should be given 3 months after additional dose; a second booster dose may be given 4 months after first booster dose. No No Age 18 and older Yes – a first booster dose of either Pfizer-BioNTech or Moderna should be given 3 months after additional dose; a second booster dose may be given 4 months after the first booster dose. Yes – a first booster dose of either Pfizer-BioNTech or Moderna should be given 3 months after additional dose; a second booster dose may be given 4 months after the first booster dose. Yes – a first booster dose of either Pfizer-BioNTech or Moderna should be given 2 months after additional dose; a second booster dose may be given 4 months after the first booster dose.
In accordance with CDC guidance, we are not requiring proof or additional documentation that you are immunocompromised. You will be asked to self-attest to having a compromised immune system.
We currently do not recommend checking antibody levels after vaccination for all patients. There are several factors to consider. First, most commercially available antibody tests are qualitative, meaning that they only test for the presence or absence of antibodies against the SARS-CoV-2 spike protein, but they do not determine the level of antibodies present. Second, we currently do not know the level of antibodies that confers protection against COVID-19 disease. Third, vaccines provide immunity through non-antibody mechanisms; therefore, a transplant recipient or immunocompromised patient will develop some protection even in the absence of detectable antibodies.
Bone marrow transplant recipients and cancer patients who undergo chimeric antigen receptor (CAR) T-cell therapy, sometimes referred to as cell-based gene therapy, should be revaccinated at least 3 months (13 weeks) after their bone marrow transplant or CAR-T cell therapy if they received their COVID-19 vaccine prior to or during treatment with a bone marrow transplant or CAR-T cell therapy. Revaccination with a primary dose of either the Pfizer or Moderna vaccine is preferable regardless of the previous vaccine administered. An additional primary dose at least 28 days after the second primary dose is recommended as part of revaccination for people who continue to have moderate or severe immune compromise.
Solid organ transplant recipients (for example liver, kidney, lungs, pancreas or heart) do not need to be revaccinated.
COVID-19 Information for Transplant Patients
We are continuing to perform heart transplants, deceased and living related donor kidney and pancreas transplants, and liver transplants without any reduction in service. For our patients, the risk of health complications due to organ failure far exceeds the risks associated with contracting COVID-19 through the transplant process. All donors and recipients are being tested for COVID-19 immediately prior to transplant surgery.
You should continue to get your routine labs drawn unless your transplant team instructs you differently. Monitoring your labs routinely is critical to the continued success of your transplant.
Get vaccinated and encourage your household and close contacts to get vaccinated as well. Wear a mask in public spaces and avoid indoor crowds whenever possible. Practice social distancing by maintaining a distance of 6 feet or 2 meters from others as much as possible. Use alcohol-based hand sanitizers frequently. Carry a small bottle around with you to make sure that you have access to it. After using the bathroom or when your hands are visibly dirty, wash your hands using soap and water for 20 seconds. Remember to clean the ‘webs’ between fingers and thumbs. Cover your mouth and nose with a tissue when you cough or sneeze, and put your used tissue in a waste basket. If you don’t have a tissue, cough or sneeze into your upper sleeve or elbow, not your hands. If you’re wearing a mask, cough or sneeze inside your mask. Avoid touching your face, particularly your eyes or nose, with your hands.
Yes. In general, transplant patients must always exercise caution about being in crowded situations. With the COVID-19 risk, we strongly recommend that you and your caregivers practice social distancing and adhere to your state and local authority’s public health orders.
The CDC recommends wearing masks in public settings, at events and gatherings, and anywhere you will be around other people. Effective February 2, 2021, masks are also required on planes, buses, trains, and other forms of public transportation. Masks or cloth face coverings should not be used by anyone who has trouble breathing, is incapacitated or otherwise unable to remove the mask without assistance. Remember that the face cover is meant to protect other people in case you are infected and does not replace other methods of reducing your risk of infection, such as maintaining a distance of 6 feet from others and frequent hand hygiene. A properly fitting mask needs to fit snugly against the sides of your face without gaps and completely cover your nose, mouth, and chin.
We recommend that transplant patients and their immediate household contacts avoid both domestic and international travel at this time.
Transplant patients have weakened immune systems and may be at increased risk for developing COVID-19.
Effective treatments now exist for treating patients with COVID-19 who have mild or moderate symptoms. The goal of treatment is to prevent symptoms from getting worse and to prevent hospitalization. Many transplant recipients, particularly those that are fully vaccinated, may only experience mild and self-limiting symptoms. In these cases, treatment may not be necessary. You should contact your primary care physician and/or transplant team (to discuss treatment options if you develop a COVID-19 infection.
Sotrovimab is a laboratory-made antibody that blocks the SARS-CoV-2 virus from infecting human cells. It is given as an intravenous (IV) infusion in the Emergency Department. It is currently only available by appointment and is available in limited supplies.
Paxlovid (Nirmatrelvir plus Ritonavir) is an oral anti-viral medication that prevents the SARS-CoV-2 virus from replicating. Paxlovid has a strong drug interaction with many of the anti-rejection medications (tacrolimus, cyclosporine, sirolimus, and everolimus), which can cause levels of anti-rejection medications in the blood to increase significantly, resulting in kidney failure and other serious toxicities. Therefore, this drug is not recommended for transplant recipients.
Remdesivir is now approved for mild to moderate disease in outpatients. It is administered intravenously once daily for three days. Availability is extremely limited because of the isolation requirements needed during infusion for 3 consecutive days.
Molnupiravir is another oral anti-viral medication that prevents the SARS-CoV-2 virus from replicating. It is not as effective as Sotrovimab or Paxlovid but does not have any drug interactions with anti-rejection medications and is generally well tolerated.
For patients who are sick enough to require admission to the hospital due to the need for oxygen therapy, other effective treatments include remdesivir, an antiviral medication that blocks replication of the virus, and medications such as dexamethasone, baricitinib, and tocilizumab, which work by reducing the body’s inflammatory response to COVID-19 infection.
There are many causes of flu-like symptoms. We recommend that you take a home COVID-19 antigen test, schedule a COVID-19 PCR test, and/or consult with your primary care physician as soon as possible. Do not change your immunosuppression. If you test positive for COVID-19, reach out to your primary care physician and/or your transplant team to discuss treatment options and the length of time that you need to quarantine. In general, transplant recipients should quarantine for 20 or more days (day 0 is the first day of symptoms or a positive viral test) because they have a longer infectious period compared to patients who are not immunocompromised. Please ensure that you have adequate immunosuppression and other transplant-related mediations at hand.
Patients who develop respiratory difficulty should go to the nearest emergency room.
Your transplant physicians and nurses are available to answer questions and provide direction by phone and MHO.
EVUSHELD has received FDA emergency use authorization to prevent COVID-19 infection in patients who are immunocompromised or in whom vaccination is not recommended due to a history of severe adverse reaction. It is given as two intramuscular (IM) shots in the buttocks. EVUSHELD is not a vaccine but rather works by preventing the virus from infecting human cells. It is currently available in very limited supplies, and we do not know if the drug’s efficacy is retained against the Omicron variant. Additionally, in one of the clinical trials testing the drug’s efficacy, an increased number of heart events (heart attacks and heart failure) was observed in the patients taking EVUSHELD. Because of these considerations, we are not widely recommending EVUSHELD at this time. You should discuss your individual situation with your primary care physician and/or transplant physician to determine if EVUSHELD is appropriate for you.
ACE-inhibitors and angiotensin receptor blockers (ARB) are medications that are used to control high blood pressure and to treat heart failure and other heart conditions. Currently, there are no studies to show that these medications are either helpful or harmful in patients with COVID-19. Furthermore, these medications are protective of heart disease, renal failure and stroke. Therefore, we strongly recommend that you continue taking your medications as prescribed.