Researchers recommend COVID-19 vaccination prior to organ transplant
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Solid organ transplant recipients, including liver transplant recipients, are likely at an increased risk for severe COVID-19, therefore researchers recommended priority vaccination status for patients’ pre-transplantation.
“Transplant patients are at higher risk for severe COVID-19 infection, we have found many reports show once infection is acquired by these immunosuppressed patients, it may be of greater severity than in normal hosts,” Rita German, MD, University of Wisconsin department of medicine, said during the ACG Virtual Grand Round 2021. “These severe infections are likely due to a number of factors including higher rates of comorbidities, frequent contact with medical care as well as being on chronic immunosuppression.”
While compiled data assessing the impact of COVID-19 on transplant patients is conflicting, German noted transplant status itself did not associate with mortality; rather, overall mortality correlated with higher severity of the illness at presentation. Additional studies (Periera, et al. Transl Infect Dis. 2021 and Kates, et al. Clinical Infectious Dis. 2020) observed that, while a factor, chronic immunosuppression was not an independent risk factor for poorer outcomes, 28-day mortality (20.5%) among hospitalized transplant recipients instead associated with older age, lung disease, congestive heart failure and obesity.
Further research investigating immunogenicity to the mRNA COVID vaccines yielded antibody responses ranging from 30% to 58% with antimetabolite-containing immunosuppression (ie, mycophenolate mofetil) negatively influencing immune response. Among liver transplant recipients in particular, research demonstrated a 50% antibody response rate following a second mRNA vaccine dose. Although, compared with healthy control participants, response rates amount to approximately half of the population (100% vs. 47.5%; Rabinowich, et al. J Hepatology. 2021), age served as a predictor of vaccine failure (OR = 1.3; 95% CI, 1.17-1.95).
Due to the risk for severe breakthrough infection among immunocompromised transplant recipients following vaccination compared with the general population (82-fold higher risk for infection, 9.3% mortality rate), a hot-button topic of research has been a third dose of the COVID-19 vaccine. Though this is not yet FDA recommended, reassuring immunity response rates warrant further study.
“We're recommending this third dose of the mRNA vaccine at least 28 days after the second dose,” German concluded. “With this third dose, the benefits outweigh the potential risks.”
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German R. Special COVID-19 vaccine update. Presented at: ACG Virtual Grand Rounds 2021; August 31 (virtual).
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