People who have undergone a transplant are more likely than the general public to have a bad reaction to COVID-19. 1 However, some transplant patients are concerned about the safety of the COVID-19 vaccine. There are also worries regarding whether the SARS-CoV-2 virus (which produces COVID-19) or COVID-19 immunizations would conflict with transplant recipients’ everyday meds. Learn why transplant recipients are more susceptible to severe COVID-19, why immunization is so important, and how to be safe.
Transplant and COVID-19 Risk
The Centers for Disease Control and Prevention (CDC) keeps its list of linked medical disorders that put persons at risk for severe COVID-19 up to date. These illnesses include:
- Being hospitalized
- Needing intensive care
- Needing a ventilator to breathe
The most significant risk factor for poor COVID-19 results is still age. 3 Furthermore, as the number of underlying medical disorders grows, the likelihood of acquiring severe COVID-19. 3 These are some of the conditions:
- Chronic kidney disease
- Chronic liver disease
- Chronic lung disease
- Heart conditions
People who have received a solid organ transplant (SOT) or a hematopoietic stem cell transplant (HSCT) are at an increased risk of developing severe COVID-19. This is primarily due to:
- Medical disorders that coexist, such as chronic kidney or liver disease
- The transplant itself
- The requirement for immune-suppressing medicines
To prevent donor organ rejection, people who have had a transplant must take medicines that suppress the immune system. When a person has a transplant, the body’s immune system sees the new organ or tissue as a foreign invader, which assaults it.
Immunosuppressive drugs impact this process, allowing transplant patients to enjoy longer and better lives. On the other hand, immunosuppression puts a person at risk for additional infections and serious complications. COVID-19.
Complications of Transplants and COVID-19
In anybody, the most worrying COVID-19 complication is severe illness or death. Respiratory failure and/or multiple organ failure are considered critical illnesses.
COVID-19 was severe in 148 SOT patients in a countrywide study of US transplant centers done in March 2020. The theme of COVID-19 was:
- Mild in 54% of recipients
- Moderate in 21% of recipients
- Critical in 25% of recipients
The mortality rate among transplant patients hospitalized with COVID-19 has been as high as 28%. This is significantly greater than the average population’s 1%–2% death rate. Within a month of receiving a COVID-19 diagnosis, a death rate of roughly 32 percent–33 percent was discovered in a study of 318 HSCT users. Whether the transplant was allogeneic, meaning it came from someone else, or autologous, meaning it came from the recipient, the death rate was the same.
According to one study, COVID-19 infection resulted in a 25% death rate among heart transplant recipients. Acute renal injury, damaged organs, and extended COVID-19 treatment are some of the other COVID-19-related issues in transplant patients (ongoing or returning health problems due to the illness).
Acute Kidney Injury
Acute renal damage is one of the most common consequences in COVID-19 hospitalized patients, aside from respiratory and organ failure. This issue is especially problematic for those who have had a kidney transplant. It can, however, happen in other types of transplant recipients.
According to one research, approximately 32% of liver transplant patients required dialysis due to acute renal damage during COVID-19 hospitalization. Acute kidney damage is not always permanent. Despite this, one study found that 11% of kidney transplant recipients had graft loss (the loss of the transplanted kidney).
Damage to Transplanted Organs
Other issues that arise in SOT patients are injuries to the transplanted organ. According to researchers, approximately 76 percent of heart transplant recipients experienced cardiac damage as a result of the infection. Lung transplant patients at a single New York City clinic were more likely to require critical care. They had a near-100 percent death rate if they required artificial ventilation to help them breathe.
Finally, persons who have had a transplant may be more prone to lengthy COVID. Although more study is needed to better explain this chronic condition, some experts believe that patients with several underlying medical issues and those hospitalized for COVID-19 are more likely to develop protracted COVID.
Researchers are currently trying to determine which populations are most vulnerable to COVID-19-related chronic illnesses. According to a recent study, four characteristics raise the likelihood of having lengthy COVID. Researchers are currently trying to figure out what variables put people at risk for extended COVID. According to the CDC, even persons who did not have major COVID-19 symptoms can acquire post-COVID problems.
Furthermore, it was first assumed that COVID-19 patients who were hospitalized were more prone to develop protracted COVID. However, it’s unclear if the long-term problems are caused by the sickness or by the impacts of being in the hospital for a long time.
Transplant Treatments and COVID-19
Treatments that suppress the immune system are usually continued after a transplant. These therapies are required to prevent the immune system from attacking the transplanted tissue. While these medications help patients who have received transplants live longer, they also put them at risk for additional infections or severe COVID-19. As a result, transplant recipients must pay special attention to handwashing, social distance, mask-wearing, and immunization to avoid infection.
Adjusting Immunosuppressive Medication Doses
If someone who has had a transplant develops COVID-19, they should see their transplant physician before changing their immunosuppressive medication. 1 Changing the medications on their own can lead to serious complications with the transplant.
Furthermore, specialists are divided on whether patients should continue, modify, or discontinue immunosuppressive therapy at this time. While it’s understandable that continuous medication reduces a person’s capacity to fight COVID-19, there’s also evidence that some immunosuppressive drugs can assist avoid severe COVID-19.
Healthcare professionals should also be aware of drug-drug interactions between COVID-19 and immunosuppressive therapies. Cellcept (mycophenolate), Protopic (tacrolimus), and cyclosporine are disease-modifying antirheumatic drugs (DMARDs) that can be harmful if the body’s levels are too high. When new medications, such as those used to treat COVID-19, are given to persons already taking immunosuppressants, an interaction between the two can cause all of the drugs’ blood levels to alter.
Because immunosuppressive treatments are not processed as fast as other drugs, they may pile up and become toxic. If the metabolism speeds up, the levels of immunosuppressive drugs in the blood will decrease. The medications will then fail to work as expected, placing a transplant recipient in danger of organ rejection.
Toxicity of COVID-19 Treatments for Transplant Recipients
Furthermore, certain COVID-19 medications might cause problems for specific transplant recipients and harm the transplant itself. Veklury (remdesivir), Actemra (tocilizumab), and Olumiant (baricitinib), for example, have been linked to increased liver enzymes, which can be especially concerning for liver transplant recipients.
Finally, several COVID-19 therapies, such as dexamethasone, Actemra (tocilizumab), and Olumiant, are immunosuppressants (baricitinib). If these drugs are used to treat a COVID-19-positive transplant recipient, the patient will be at risk for additional infections.
How to Stay Safe
Aside from getting vaccinated, the following are the best measures for transplant patients to keep safe:
- Washing hands
- Wearing a mask
- Social distancing
- Avoiding large crowds
This advice also applies to patients who have had a transplant and have been completely vaccinated, as immunization is unlikely to result in a substantial antibody response. Immunocompromised people’s vaccination schedule contains an additional dose as part of the primary series, and the vaccine timing changes from healthy people’s. Household members and close contacts of transplant recipients must also get vaccinated as soon as possible to protect themselves from infection.
COVID-19 is far more likely to cause problems and death among transplant recipients than it is in the general population, according to researchers. They are also at a higher risk of getting the virus, owing to their frequent interactions with the healthcare system, concurrent medical problems, and the necessity to take immune-suppressing medicine.
The possible consequences are acute renal injury, a lengthy COVID, and organ damage. After a transplant, interactions between COVID-19 medicines and needed immunosuppressive drugs can potentially harm donated organs, so the virus isn’t the only risk.
Experts and transplant experts must play a significant role in transplant patient care. Because persons who have had a transplant do not generate significant antibody responses to immunization, vaccination is critical, especially with the additional booster doses necessary for transplant patients.