Dr. Vivek Kute

Professor – Nephrology and Transplantation

Institute of Kidney Diseases and Research Centre and

Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India

Secretary, Indian Society of Organ Transplantation (ISOT)

1. What are the COVID-19 vaccine guidelines for Transplant Recipients?

Based on other vaccine guidelines for solid organ transplant recipients, Transplant societies suggest that transplant recipients and their household members should get vaccinated with any COVID-19 vaccine that is authorized or approved by their health regulator's agencies. Transplant recipients scheduled for transplantation, should be given vaccine two weeks prior to surgery or one to six months post-transplant. Even after vaccination, COVID-19 appropriate behaviors like wearing face mask, hand hygiene, cough etiquette and social distancing should be continued by all recipients.

2. What Kind of vaccines are available or under development to prevent COVID – 19?

There are currently several vaccine candidates under development. The types of vaccines are as follows:

3. When will these vaccines become available to transplant recipients?

Both Pfizer and Moderna vaccines have filed for Emergency Use Authorization (EUA). Currently the CDC Advisory Committee on Immunization Practices (ACIP) are considering the following groups for early vaccination in a phased distribution:

• Healthcare personnel
• Residents of long-term care facilities
• People at high risk for severe COVID-19 illness due to underlying medical conditions
• People 65 years and older

In India, vaccines have been made available on priority basis to frontline healthcare workers. Next round of vaccination may be made available to population over 50 years of age.

4. What is known about the safety of these vaccines?

The safety profile of the mRNA SARS-CoV-2 vaccines administered to over 70,000 participants have not revealed any significant concerns at a median of 2months follow up. The mRNA SARSCoV-2 vaccines, similar to other common vaccines, are noted to cause fevers, muscle aches, and headaches; most are mild to moderate in severity, but some may be severe enough to briefly limit activities and typically resolve within 1-2 days. The safety of mRNA vaccines is still under investigation in solid organ transplant recipients. Expert opinion is that based on their mechanism of action, they are unlikely to trigger rejection episodes, but more data will be needed in transplant recipients.

5. How effective are these vaccines in transplant recipients?

The Pfizer and Modern a mRNA vaccines have data in immunocompetent people showing 94.1-95% efficacy in preventing infection with COVID-19.When breakthrough infection occurs, disease is generally mild, showing the vaccines are also effective in preventing severe disease. It currently appears that antibody titers persist for at least 4 months.

The effectiveness of COVID-19 vaccines will need to be further studied in the solid organ transplant recipient. Solid organ transplant recipients may have generally lower antibody responses than those without transplants. Likewise, waning titers to other routine vaccines are well documented after transplantation. Lastly, patients vaccinated pre-transplant, may have reduced protection post-transplant, particularly if therapies that reduce B–cell function(e.g. rituximab) are utilized.

6. When should a transplant recipient or candidate receive these vaccines?

Based on previous vaccination guidelines for solid organ transplant recipients, it is recommended that all transplant candidates and their household members receive vaccination when it becomes available. In general, vaccines are recommended more than 2 weeks prior to transplantation, or starting at 1-6months after transplantation.

7. Can a transplant recipient still receive the vaccine even if they have had COVID19?

The current guidance is that everyone receives the vaccine, irrespective of pastCOVID19 infection. There are case reports of immunosuppressed patients developing COVID-19 reinfection, suggesting lack of appropriate immune response or waning immunity after the first infection.

8. Are there other things that transplant recipients need to consider about the vaccine?

While data are currently lacking specific to the vaccine in transplant recipients, it is reasonable to anticipate that vaccination will offer benefit. Transplant recipients appear to have clinically worse outcomes from SARS-CoV-2infection compared to non-transplant recipients due to comorbidities or immunosuppression. Thus, the benefits of vaccination outweigh any theoretical risks especially in countries where SARS-CoV-2 transmission continues at a high level.

9. Is there anyone who should NOT get the vaccine?

People with a history of allergic reactions to vaccines or other medicines should talk to their transplant physician about getting the vaccine. The CDC states that this is a precaution, not a contraindication to getting the vaccine. So far, vaccines have only been recommended for individuals more than 18years of age by the Ministry of Health and Family Welfare (MoHFW).

10. Can I get COVID-19 from the vaccine?

No. The vaccine does not contain live virus.

11. Do I need to continue to take extra precautions once I am vaccinated?

Yes. There is not enough information on the protective immunity from the COVID vaccine in transplant recipients. We recommend that you maintain precautions including frequent hand washing, wearing a mask and physical distancing.

12. Can I be vaccinated against other infections?

Until more data are available, other vaccines should not be administered 2weeks before or after the COVID-19 vaccine.

13. Can I get the vaccine if I currently have COVID-19?

No. The vaccine should only be administered after recovery. You will need to be cleared for the vaccine after you recover from COVID-19 by your transplant physician.

14. Is the vaccine safe if I am pregnant?

COVID-19 vaccines have not been recommended for pregnant and lactating women until more research is completed.

15. Should I continue to take my immunosuppressive medications?

Yes. However, if you develop any signs of illness, such as fever or respiratory symptoms, contact your medical team for guidance on whether to continue these medications.

16. Have the various transplant societies recommended the vaccine to transplant recipients?

Vaccination of transplant recipients has so far been advocated by several societies/ organizations:

• American Society of Transplantation
• London Health Sciences Centre
• British Transplantation Society
• NKF – National Kidney Federation
• MoHFW guidelines (INDIA) recommend vaccine for immunocompromised patients.

17. Can I take vaccine if I have comorbidities? 

Yes. Patients with diabetes, hypertension, COPD, kidney diseases, liver diseases can be given COVID vaccine.

18. Is interchangeability of vaccines permitted?

No. Patients who have received first dose of Covishield vaccine must take second dose of Covishield vaccine only, and vice versa.

Please see the details of Government of India COVID-19 vaccine operational guidelines updated as on 28 December 2020.

Disclaimer: COVID-19 pandemic is evolving in a dynamic manner, therefore, this COVID-19 vaccine guideline is a live and dynamic document and will be updated as per the evolving situation