Q&A: Transplant Patient Immune Response to COVID-19 Vaccines
CareDx and the Lung Transplant Foundation hosted the “COVID-19 Vaccines and the Latest Data on Immune Response in Transplant Recipients” webinar on May 12, 2021. More than 1,000 transplant recipients, caregivers, and clinicians tuned in to the live webinar to hear the latest research on the immune response of transplant recipients to the COVID-19 vaccine.
Dorry Segev, MD, PhD, a transplant surgeon from Johns Hopkins Medicine, and one of the authors of a recently published study in the Journal of the American Medical Association (JAMA) that looked at the antibody response in more than 650 transplant patients, presented findings and answered questions.
Below is a summary of some of the questions posed during the session.
1. Is it safe for transplant recipients to get vaccinated? Which vaccine is preferable and is it affected by underlying medications or time since transplant?
Answer: From the data we have so far, the current COVID-19 vaccines appear to be safe in transplant recipients with no increase in rejection rates or other complications. Patients and their caregivers should get vaccinated at the earliest available opportunity. Although the patient’s medications can affect the antibody response, preemptive changes in medications can be risky and is not recommended at this time. Any differences in vaccine response are limited to small case studies, and the general recommendation is the best vaccine is the one available to you.
2. What is the rate of antibody formation after the first dose, second dose, and different types of vaccines?
Answer: As published in JAMA, the rate of antibody formation after the first dose of mRNA vaccination (both Pfizer and Moderna) is about 20%, and after the second dose is 57%. The rate of antibody formation does not appear to be better with the Johnson & Johnson vaccine. Between Pfizer and Moderna, the difference is not large enough to recommend one vaccine over another.
3. Is antibody formation a clear indicator of protection or no protection?
Answer: No. Antibodies are just part of the immune response. It is possible that a robust antibody response may still not offer complete protection against COVID-19, because things like T cell response can still be impaired. While the lack of antibody response may not necessarily translate into a complete lack of protection from vaccination, it is not a great sign.
4. Is it important to continue COVID-19 protection, especially in light of relaxed COVID-19 restrictions by the Centers for Disease Control (CDC)?
Answer: Absolutely. It is recommended by the American Society of Transplantation that transplant recipients continue to maintain COVID-19 protection because vaccination may not impart the same protection to them as they would to the general public. A good rule of thumb is to get vaccinated but to follow the CDC guidelines for unvaccinated people for now.
5. Should I consider a third dose of vaccination?
Answer: This is an area of ongoing debate and discussion. We do not know how much protection is imparted by two doses of vaccine. We also do not know the benefits and risks of an additional dose. Thus, currently, we do not have evidence to recommend an additional vaccination dose but we do suggest staying in touch with your transplant team to get the most updated information.
6. Should I be tested for antibodies?
Answer: At this time, there is limited role of antibody testing for routine clinical care, because no matter what your antibody test shows, we would still recommend the protective behaviors discussed in #4. However, this may change in the future and should be discussed with your transplant team.
Note that since Dr. Segev presented this webinar, his team has published additional information suggesting that a third dose of COVID-19 vaccine maybe a benefit for transplant patients with low levels of antibodies: https://www.acpjournals.org/doi/10.7326/L21-0282
The recording of the one-hour webinar is available on-demand here: https://vimeo.com/548694024/2f377e2579
The referenced JAMA article, titled “Antibody Response to 2-Dose SARS-CoV-2 mRNA Vaccine Series in Solid Organ Transplant Recipients” can be read here: https://jamanetwork.com/journals/jama/fullarticle/2779852
Always seek the advice of your physician or medical team with any questions you may have regarding your specific medical condition. The information is not intended or implied to be a substitute for professional medical advice from your healthcare provider.