COVID-19 vaccination advice for heart and lung transplant recipients

The vaccine has been developed with unprecedented speed but is based on expertise and research on coronaviruses as well as vaccine development for other novel viruses. All vaccines  must meet very strict safety and effectiveness standards as set by our national and international regulatory authorities.  

Although this is the first licensed mRNA vaccine, mRNA vaccines have been extensively researched for cancer and infectious diseases. The approved mRNA COVID-19vaccine has been administered to over 70,000 participants without any significant concerns by the first 2 months follow up. It can cause fevers, muscle aches, and headaches which typically improve within 1-2 days. There are no available data so far regarding any long-term complications/side effects from the mRNA COVID-19vaccine (or any of the other COVID-19 vaccines currently in development) but there has been no indication of long term risks so far. 

Similarly, specific data on safety in immunocompromised transplant recipients is also unavailable but it is not expected to differ from the studied population.  Based on previous vaccination guidelines for heart and lung transplant recipients, we do not expect safety to be different in this instance.

The safety of mRNA vaccines is still under investigation in solid organ transplant recipients. According to advice from the American Society of Transplantation (AST) and the International society for Heart and Lung Transplantation (ISHLT), they are unlikely to trigger rejection episodes. This is based on experts’ opinion at present, but transplant recipients will be monitored closely.

The effectiveness of the first COVID-19 vaccine (Pfizer/BioNTech) is impressive and in the range of more than 90%. Similarly, the effectiveness of the Oxford/AstraZeneca vaccine (currently awaiting approval) is in the range of 70%. In the small number of people who catch COVID-19 after having the vaccine - it appears to protect against severe COVID-19 infection and complications.

We do not know yet for how long the vaccination will protect from infection but so far antibodies appear to be present at 4 months after vaccination.

Based on previous experience with other vaccinations, immunogenicity (the protective response to vaccine) could potentially be limited in patients with a reduced immune system so the effectiveness of the vaccine in Heart and Lung Transplant patients will need to be studied further.

As your transplant team we advise you to receive the COVID-19 vaccine. COVID-19 immunisation is encouraged by NHS-Blood & Transplant and the International Society for Heart and Lung transplantation, in patients with advanced heart or lung disease and Pulmonary Vascular Disease, or in those awaiting or following heart or lung transplantation, when a vaccine is locally available.

You may NOT be suitable for the vaccine in the following cases. Please get in touch with us to discuss if:

• You have had a Heart and Lung Transplant within the last 6 months.
• If you have had significant increase in your immunosuppression recently such as ECP, TLI, Immunoabsorption, Rituximab or RATG. 
• If you have had severe allergic reactions in the past.

The American Society of Transplantation (AST) recommends household members of transplant recipients are offered vaccination too.  In the UK, the Joint committee for Vaccination and Immunisation (JCVI) does not include family members of extremely vulnerable individuals in the priority list for vaccination. If possible, we would be supportive of family members being offered vaccination as well.

In the post transplantation setting, the ideal timing of vaccination is uncertain. It is recommended to delay vaccination at least one month from transplant surgery and 3-6 months from use of T-cell depleting agents such as anti-thymocyte globulin or specific B-cell depletion agents such as Rituximab; in the latter case assessment for recovery of B-cells prior to vaccine initiation may be considered. Please discuss with us if you have been transplanted in the last 6 months. 

Please also see question above: “So as a Heart and OR Lung Transplant recipient, should I have the vaccine?”

The current guidance is that everyone receives the vaccine, irrespective of past COVID-19 infection. The same applies if you previously had positive antibodies for COVID-19. 

There are case reports of COVID-19 reinfection in immunocompromised patients which means that either protection after a first infection is inadequate or decreases with time.

No, the vaccines will be offered via your GP. Invitation to attend for vaccination may come via GP practices or from hospitals and all patients may expect to receive their invitation by January/February 2021.

Prioritisation for vaccination is made according to the advice from the Joint Committee on Vaccination and Immunisation (JCVI). Solid organ transplant recipients are classified as extremely clinically vulnerable and should be vaccinated at same time as people aged 70-74 years of age.

We will be keeping a register of all our patients who have had the COVID-19vaccine so please let us know that you have had the COVID-19vaccine by your GP.