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Review
. 2023 Apr 1;28(2):76-84.
doi: 10.1097/MOT.0000000000001056. Epub 2023 Feb 15.

Update on Covid-19: vaccines, timing of transplant after COVID-19 infection and use of positive donors

Catherine-Audrey Boutin  1 , Maha Alamri  1 , Michael G Ison  2
Affiliations
Review

Update on Covid-19: vaccines, timing of transplant after COVID-19 infection and use of positive donors

Catherine-Audrey Boutin et al. Curr Opin Organ Transplant. .

Abstract

Purpose of review: SARS-CoV-2 resulted in a global pandemic that had a chilling effect on transplantation early in the pandemic and continues to result in significant morbidity and mortality of transplant recipients. Over the past 2.5 years, our understanding of the clinical utility of vaccination and mAbs to prevent COVID-19 in solid organ transplant (SOT) recipients has been studied. Likewise, approach to donors and candidates with SARS-CoV-2 has been better understood. This review will attempt to summarize our current understanding of these important COVID-19 topics.

Recent findings: Vaccination against SARS-CoV-2 is effective in reducing the risk of severe disease and death among transplant patients. Unfortunately, humoral and, to a lesser extent, cellular immune response to existing COVID-19 vaccines is reduced in SOT recipients compared with healthy controls. Additional doses of vaccine are required to optimize protection of this population and still may be insufficient in those who are highly immunosuppressed, those receiving belatacept, rituximab and other B-cell active mAbs. Until recently, mAbs were options for the prevention of SARS-CoV-2 but are markedly less effective with recent omicron variants. SARS-CoV-2-infected donors can generally be used for nonlung, nonsmall bowel transplants unless they have died of acute severe COVID-19 or COVID-19-associated clotting disorders.

Summary: Our transplant recipients require a three-dose mRNA or adenovirus-vector and one dose of mRNA vaccine to be optimally protected initially; they then need to receive a bivalent booster 2+ months after completing their initial series. Most nonlung, nonsmall bowel donors with SARS-CoV-2 can be utilized as organ donors.

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Conflict of interest statement

C.A.B. and M.A. have no relevant conflicts to disclose. M.G.I. received research support, paid to Northwestern University Feinberg School of Medicine, from GlaxoSmithKline, royalties from UpToDate and was a paid consultant for Adagio, ADMA Biologics, Adamis, AlloVir, Atea, Cidara, Genentech, Janssen, Roche, Shionogi, Takeda, Telaris and Viracor Eurofins; all of these activities ceased 4 December 2022.

Figures

Box 1
Box 1
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FIGURE 1
FIGURE 1
SARS-CoV-2 vaccine platforms and antigens.
FIGURE 2
FIGURE 2
Current US centres for disease control recommendations for SARS-CoV-2 in immunocompetent and immunocompromised patients.
See this image and copyright information in PMC

References

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Supplementary concepts