Linda Monich, living kidney donor, shares what her experience was like donating a kidney to her husband, Tim, at the Massachusetts General Hospital Transplant Center.
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.
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.
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.
What You Need to Know About the Covid-19 Vaccine & Kidney Transplantation
In a recent patient webinar, Mass General transplant and infectious disease experts discussed research and recommendations for transplant patients and the COVID-19 vaccine.
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When Ann Foti learned that she could become a living donor for her husband, Gino, she was determined to donate her kidney to him; however, because of complications with Gino’s condition and the onset of the COVID-19 pandemic, their journey toward transplantation surgery was far from simple.
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Learn More about the Transplant Center
The only center in the region to offer adult patients transplantation for every organ, the Mass General Transplant Center is a destination for any patient requiring transplantation, including multiple organ transplants and advanced care options.