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Q&A – Transplant Talk – COVID Vaccinations for Transplant Recipients and Dialysis Patients 

Adults 

1. How will the anti-rejection drugs affect the body’s response to the antigens in the vaccine?
   We don’t know for certain , but based on experience with other vaccines we predict the immunosuppressants (anti-rejection drugs) may reduce the response to COVID-19 vaccines a little, but predict the vaccine will still have effect.
2. Can People with immunosuppression safe to take AstraZeneta vaccine?
   Yes. The COVID-19 vaccines planned for use in Australia including the AstraZeneca vaccine are not live vaccines.
   
3. Does the vaccine contain a live virus. I was told, as renal recipient, that we should not be administered ‘live” vaccines.
   The COVID-19 vaccines planned for use in Australia including the AstraZeneca vaccine are not live vaccines.
4. Adenovirus triggered/caused my chronic rejection in 2016 & I was finally re-transplanted towards the end of last year – am I safe to get the AstraZeneca vaccine?
   Unlike adenovirus infections, the adenovirus vector in the AstraZeneca vaccine does not replicate (multiply/proliferate). We do not predict that it will cause organ rejection.
5. What percentage of people who undertook the vaccine trials were transplant (specifically kidney transplant) patients and what was the outcome of the trials on those people?
   Transplant patients were excluded from the COVID-19 vaccine trials to date. We have preliminary data from John Hopkins Medicine suggesting vaccination does not cause different side effects compared to the regular population. COVID-19 causes severe disease in transplant patients, so we strongly suggest you get the COVID-19 vaccine offered to you.
   
6. Being that transplant patients take anti-rejrction drugs etc to prevent an immunsystem. how does the vaccine work for transplant patients if they don’t have that immune system to build the cells to fight against covid-19?
   Based on experience with other vaccines we predict the immunosuppressants (anti-rejection drugs) may reduce the response to COVID-19 vaccines a little, but predict the vaccine will still have effect.
   
7. Are children of Transplant recipients going to be given separate advice regarding vaccination, or will they be treated as per “ordinary” children?
   From the information available to us at this time, we think family members of transplant patients (including children who have had transplants) will have to wait for their turn to be vaccinated. Even children who are immunosuppressed have a low rate of serious COVID-19 infection compared to immunosuppressed or elderly adults.
   
8. What about patients waiting for transplant? Where do they fit?
   Patients waiting for transplant will be prioritised for vaccination like transplant recipients. They are in phase 1b of the vaccine rollout.
9. If Pfizer has not tested for immunocompromised, how could the post transplant be suitable?
   Based on experience with other vaccines we predict the immunosuppressants (anti-rejection drugs) may reduce the response to COVID-19 vaccines a little, but predict the vaccine will still have effect. We do not expect any different side effects compared to the general population nor do we expect vaccine to cause organ rejection- this is supported by preliminary results from John Hopkins Medicine.
   
10. Clarification – were there any trials or patients in any testing groups transplant patients? If not how can you be sure the impact on patients and risks?
    Based on experience with other vaccines we predict the immunosuppressants (anti-rejection drugs) may reduce the response to COVID-19 vaccines a little, but predict the vaccine will still have effect. We will have more information coming through soon, but we do not expect any different side effects compared to the general population nor do we expect vaccine to cause organ rejection- this is supported by preliminary results from John Hopkins Medicine. Because COVID-19 often causes severe disease in organ transplant patients, we strongly suggest you get vaccinated when this is offered to you.
    
11. How long will infection control occur after the second vaccination? Will we need a vaccine annually as we do for the flu vaccine?
    Protection in the trials has been examined for about 2 months so far, but we will get more information as individuals in the trials are followed for longer. It is likely that further doses of vaccine are required in future.
    
12. The vaccine reactions are similar to the anti rejection medication such as tacrolimus is there any data on this?
    The reactions to the vaccine are not generally confused with anti-rejection drugs or other medications. The vaccine side effects occur in the day or so after the vaccine and last for a short time.
    
13. What do we need to do after receiving the vaccine? What happens then?
    You can be less anxious about being infected with COVID-19, but until a lot of the population here and overseas is vaccinated and we have further information of protection by the vaccine in transplant patients, you still need to wash your hands and socially distance.
    
14. Given the immunosuppressed state of transplant patients, what sort of protection can we expect from the vaccine, using Pfizer vaccine’s 95% efficacy as a guide, would we expect may be 50% efficacy? I understand we may not have that information for COVID vaccine but what about based on data from other vaccines with similar efficacy, e.g. hepatitis/ measles vaccine.
    It is difficult to estimate vaccine effectiveness in transplant patients, so we will have to wait for this data, but we do expect protection against COVID-19 particuarly severe disease, as has been seen in the trials in the general population.
    
15. Which group will caregivers or close family contacts of transplantees fit in? In 1b, along with us?
    Family contacts or caregivers do not move up the vaccine queue because they have a transplant patient as a contact, so they will have to wait until their time for vaccine is due.
    
16. Do I need to have this vaccine I would prefer not
    COVID-19 can cause serious disease in transplant patients, so we strongly suggest you are vaccinated when this is offered to you.
    
17. Will my wife get the vaccine at the same time as me or will she have to wait being she is of good health and in her 30’s?
    She will have to wait.
    
18. Would we think that the systemic reactions would be less in Tx patients given immunosuppression?
    Not sure about this at the moment but this information will come through soon. We do not expect different side effects to the general population.
19. Are there any early results coming in from the John Hopkins study in the US on vaccines in transplant patients?
    Early results suggest the vaccine did not cause organ rejection and side effects were similar to the general population.
    
20. As transplant recipients i assume we fall into phase 1(b)- so do we get astra- zeneca dose?
    Phase 1b is likely to be use of Pfizer and AstraZeneca, but it is not currently clear which vaccine transplant patients will receive. You will not get a choice of vaccine.
21. Given that the annual flu vaccine will be distributed at a similar time to the covid vaccine for group 1b, should we be having the flu vaccine first, before covid vaccine?
    For caution it is recommended that influenza vaccine and COVID-19 vaccines are separated by 14 days but if they are given closer together we don’t expect this will cause any problems.
    
22. After the first 2 doses, what is planned as to the next shot to be received, given duration of protection unknown.
    Protection in the trials has been examined for about 2 months so far, but we will get more information as individuals in the trials are followed for longer. It is likely that further doses of vaccine are required in future.
    
23. Please have a breakdown on the effectiveness of other vaccines for immunocompromised individuals as compared to the optimally healthy immunity. And in turn, should recipients actually receive the vaccines and if so, which one?
    It is difficult to estimate vaccine effectiveness in transplant patients, so we will have to wait for this data, but we do expect protection against COVID-19 particuarly severe disease, as has been seen in the trials in the general population. Because COVID-19 infection can be serious in organ transplants, we strongly suggest you get the vaccine which is offered to you. You won’t get to choose which vaccine you receive, and either we expect to be effective.
24. Is there any data on how the various vaccines interact with eachother i.e. if you for example have the Pfizer vaccine initially and complete that course, and then get the Astra Zeneca or other vaccine other than Pfizer the following year (or whenever the booster is recommended) does this impact on vaccine efficacy or health of transplant patients?
    Use of different vaccines in the same person has not been tested yet, but this is the subject of planned trials.
    
25.  
26. My wife was a kidney donor, which phase does she fit in?
    Unless she has other medical illnesses, she will likely be offered vaccine based on her age.
    
27. Does type of transplant make a difference regarding COVID? Eg. Is someone with a corneal graft of more or less risk than someone with a transplant requiring blood matching?
    Some organ transplants are at higher risk of serious COVID-19 disease, such as lung transplants. Broadly speaking, the more intense the immunosuppression, the higher the risk of severe disease.
    
28. So given tx patients are in group 1b the timing suggests end of April therefore should they influenza shot in mid late March to ensure adequate time between shots.
    The timing of COVID-19 vaccine for groups in phase 1b is not exactly certain, so will have to negotiate the best time for influenza vaccine closer to the time.
    
29. What is the efficacy difference between live vaccine and non-live” vaccine.
    Live vaccines can be dangerous for immunosuppressed patients like transplant patients, but all the COVID-19 vaccines planned for Australia are not live vaccines.
    
30. what about the Israel experience and the head to head comparison between vaccines and their experience in a transplant population.
    Data have not been reported from Israel yet.
    
31. Will patients on dialysis be treated similar to transplant patients and are there other factors that need to be considered when getting the vaccine.
    Patients on dialysis will be in phase 1b like transplant patients.
    
32. I presume that donors are checked for covid?
    Yes donors are routinely screened for COVID-19 infection.
    
33. Do the stats presented for kidney transplant recipients include SPK transplant recipients?
    The data of risk for serious COVID-19 infection in kidney transplants may include some with pancreas transplant but we do not have separate data for kidney-pancreas recipients. Their risk would be expected to be the same as kidney recipients.
    
34. Any data for hearts, lungs and livers.
    Risk of serious COVID-19 infection is similar for non-kidney organ transplants to kidney transplants, however lung recipients have a higher risk of serious COVID-19 disease.
    
35. Are they still giving placebos?
    They give placebo for the study, but then those individuals will be offered vaccine as it becomes available to them.
    
36. Is long covid more prevalent in renal patients?
    Probably. “Long” COVID or persistent symptoms after infection are more common in those with severer disease, such as those requiring hospitalisation, which is more common in patients with kidney disease.
    
37. Would be when unvaccinated and contracting Covid are we less likely to develop severe lung disease given the reduced inflammation aspect of immun suppression?
    Although short course steroid (dexamethasone) is used as a treatment for severe COVID (not mild or moderate COVID where it has no effect), the immunosuppression taken to prevent rejection does not improve outcomes when infected with COVID-19. The opposite, the outcomes (including the lung involvement) are worse, probably due to the combination of immunosuppressants (not just steroids).
    
38. Are there any details on COVID vaccinations affects on Kidney TX patients who are currently being monitored for viruses such as the BK virus
    BK virus infection and disease should not impact the vaccination at all.
    
39. I’ve read that the vaccines are presumed safe for pregnant women – what is the recommendation for TX patients who are of child bearing age (looking to undergo IVF procedures).
    Neither Pfizer nor AstraZeneca vaccines have shown any adverse effects to the foetus in the small number of women who have become pregnant in the vaccine studies, and animal data does not suggest any adverse effects of vaccination on the foetus. The government stance is that pregnant women can consider being vaccinated if they have factors to increase the chance of severe COVID in pregnancy (and having a transplant is one of these). At the moment, the Pfizer vaccine has a little more data in pregnant women and is likely to be preferred if you are actually pregnant, but if you are simply contemplating pregnancy either vaccine is fine.
    
40. Is there a vaccine transplant study? Happy to volunteer if you are going to do a study on it.
    There are a number of planned studies. We would encourage you to speak to your transplant unit.
    
41. Will parents and carers of under 16 transplant patients be eligible for the vaccine before the general public, considering that the child can’t get it until they turn 16?
    Because children (even immunosuppressed children) have low rates of serious COVID-19 infection, contacts of immunosuppressed children are not planned to move up the queue at the moment.
    
42. If you donate your kidney to a living relative then should I be vaccinated.
    Donating a kidney does not make you unhealthy, so you would be considered like the general population who are all being encouraged to be vaccinated. We suggest you should be vaccinated.
    
43. Will the vaccine be as effective for those who have recently had a kidney transplant -less than 6 months, higher dose of pred and other immunosuppressive meds.
    The immunosuppression is at the highest level initially after transplant when vaccine response may not be quite as good, so we will likely suggest waiting about 3 months after transplant to get vaccinated. Formal advice should be out soon.
    
44. I have had a kidney transplant and am looking forward to getting the jab. However my partner wants to know, can he get a jab at the same time? If he doesn’t, won’t that keep me at risk?
    The priority is to protect you and If you get the vaccine that will help protect you, and the added protection of vaccination of your close contacts will occur later.
    
45. Does vaccination increase antibodies in the event you need another transplant in the future(god forbid). this would be general to vaccine not just the covid.
    The antibodies produced from the vaccine are specific against COVID and not against organs, so we do not expect these antibodies to cause problems with organ rejection, and our experience with other vaccines suggests they are safe in this regard.
46. Can we get multiple vaccines, will that improve the odds or is more than one too many?
    Individuals are likely to require more vaccine doses and perhaps different types of vaccines as time goes on, but we are not sure about this yet. Vaccines have not been mixed with each other in any trials, so you only get the one type for now.
    
47. How will I, as transplant recipient be notified for vax?
    Our understanding is the government will alert you to make an appointment via a booking system.
    
48. Since Australia has such low COVID cases, should immunosuppressed patients wait until there is more data on the vaccines before getting it?
    The future is uncertain, and one predicts travel will open up and borders become more lax with vaccination across the world, with more likelihood of circulating COVID-19 infection in Australia. The vaccines are not live so also do not expect them to cause significant adverse effects in transplant patients. So we don’t think you should delay getting vaccinated.
    
49. Will my 16 yo daughter with KT be in group 1b or group 5?
    Age 16 or over is the approval for the Pfizer vaccine, so we would think phase 1b.
    
50. What time line for vaccination post transplant ie/ if recently transplanted how long to wait before receiving vaccination.
    The guidance is yet to be formalised, but we are likely to suggest you wait about 3 months after transplant before being vaccinated to get a better response to the vaccine.
    
51. Will immediate family members get opportunity to get vaccine at same time as transplant patient?
    No, the vaccine is distributed based on where individuals come in the phases.
    
52. If you are working from home would you advise to continue to do so until you are vaccinated?
    It depends on how much COVID is circulating in the community. If COVID is not circulating in your area, it should be safe to be at work.
    
53. Should family members who may become living donors have the same vaccine?
    Living donors or family members may have a different vaccine to a patient with a transplant but there is no problem with this.
    
54. Why are the rates of death from Covid-19 higher in dialysis patients?
    We are not exactly sure.
    
55. Is there any data if it effects fertility?
    There are no signs that the vaccines affect fertility.
    
56. Will you require all potential living donors to have a vaccine before they can donate an organ?
    No
57. Do we get the vaccine from our GPs or the transplant clinic
    The government hasn’t talked about this so we are not sure at the moment. This should become clear soon.
    
58. Will the systemic reaction after the vaccine be proportionate to the antibody response (and efficacy)? any evidence so far?
    Yes there probably is an association of local or systemic reactions to vaccine response but this hasn’t been described so far
    
59. Am on dialysis take claxanne 60. can i have the vaccine
    Yes you can have the vaccine on anticoagulants. You will need advice from your doctor about management of the clexane at the time of vaccination.
    
60. What about those in rural and remote areas . Will it take us longer to get a vaccine
    No. Vaccine hubs are being set up in rural areas.
    
61. Any concerns for HTx patients with PTLD?
    Not specifically. But you will need to speak to your doctor about this situation as you may have had rituximab which does lower vaccine responses for some months after the drug.
    
62. I’ve read that there might be a fast call up available to stop wasting vaccines
    Nothing has been said by the government about this.
    
63. Is recommendation for flu Vax after 1st jab or both jabs ?
    We are not sure it makes any difference, so whatever is practical when the time comes.
    
64. Is there any extra risk to my live donor from Covid and dose that qualify for them to move higher into the vaccinationpriority list.
    No there is no additional risk of severe COVID in a live organ donor above the general population so we don’t expect they will be prioritised.
    
65. I had my transplant 3 month ago but have another condition that flared up a month after transplant Familial Mediterranean Fever, so how vaccine will effect my case?
    The vaccine is not expected to cause exacerbations of inflammatory conditions such as Familial Mediterranean Fever. We would advise you to be vaccinated.
66. Is it safe to get covid immunisation if patient had allergic reaction with flu?
    Yes. The only reason you can’t get a COVID vaccine is severe allergy to the COVID vaccine itself. If you had severe reaction (anaphylaxis) to another vaccine or drug, sting, food, you will be monitored for 30 mins rather than 15 mins after the vaccine as a measure of caution.
67. I am interested to know if there is a difference in the efficiency of the vaccines with the differing immunosuppressant drugs? The research you referred to mentioned some of the most common types of immunosuppressant drugs.
    We are not sure of this at the moment, but from research with other vaccines we know that certain immunosuppressants can affect response to vaccine more than others, but the main drugs which do this are generally given only early after transplant, or sometimes as treatment for rejection.
68. what group will pre transplant patients will be in for the vaccine
    Phase 1b because they all have organ failure.
    
69. Given there is quite a discrepancy in the efficacy of vaccines will the medical transplant community have a say in which the government give us?
    Immunisation experts continue to guide the government on the best vaccine for each particular group of society based on what is available, what the evidence shows, and what is most optimal for each group of individuals.
    
70. How long will new transplant recipients have to wait before they can get the vaccine?
    This has not been decided, but probably something like 3 months after transplant.
    
71. Is it possible to get access to John Hopkins findings and especially for transplant cases.
    The preliminary data can be found online in search engines, and look out for when the study has been finished and published.
    
72. Is there any differences for those taking cyclosporine?
    Most transplant patients take ciclosporin or the related drug tacrolimus, so there is nothing special about this drug in itself in relation to COVID or vaccination.
    
73. If I don’t have the vaccine and my dead donor has had the mRNA based vax will their kidney’s biological coding mingle with mine and hence i will have the ‘vaccine’
    The vaccine effect is short lived and does not transfer in a donated organ. Vaccine in a donor will not have any effect in the recipient.
    
74. Are any of the three vaccinations, genetically modified in anyway?
    The AstraZeneca adenovirus vector has been genetically modified to carry the gene to make COVID Spike protein, and also modified so that it won’t replicate in your body.
75. How do we keep a KT recipent safe during the period when not everyone in the household are not immunized. Also same for elderly between 1st and 2nd dose
    Protection begins 2-3 weeks after the first dose. You must continue hand hygiene, social distancing.
    
76. I am keen to travel again at some time in the future. Once vaccinated is there a way to understand how the effective the vaccine will be over time? Can you test for that?
    The duration of protection in the general population is uncertain and this will be answered by ongoing studies in this area which will take time. Also finding blood tests which are associated with protection after vaccination is an area of active research.
    
77. Would assessment of antibody be an adequate means of assessing vaccination effectivity?
    This is uncertain and an area of active research. The common antibody tests may not be a good marker of protection after vaccination, so at least in the general population are not recommended to test after vaccination.
    
78. Do we know any stats from other countries where the rates of infection have been higher amongst the transplant and dialysis community ie the UK – showing how we compare to the general public in relation to the outcome of the infection.
    Data from these countries with more burden of COVID show that dialysis and renal transplant patients are more likely to have serious disease, go to hospital, go to the ICU, and more likely to die than the general population.
79. When are we likely to see more stats on transplant immunizations ?
    This will likely come through in the next few months.
    

Paediatric

1. So at the moment no vaccination plans for transplant kids at the moment?
   Currently there is limited data of the vaccines in children so they are not currently approved for children, but this will change as further trial data comes through.
2. You note there is insufficient data for under 16 – is there sufficient data for transplant recipients?
   Currently we have limited data on use of COVID-19 vaccines in transplant patients, but do not expect different side effects compared to the regular population, we do not expect them to precipitate organ rejection, and because COVID-19 causes severe disease in transplant patients, we strongly suggest you get the COVID-19 vaccine offered to you
3. Since no data about kids below 16, so transplant kids are excluded?
   Currently there is limited data of the vaccines in children so they are not currently approved for children, but this will change as further trial data comes through.
4. If family members that reside with you are under 16, what is the recommendation regarding vaccination.
   Currently there is limited data of the vaccines in children so they are not currently approved for children, but this will change as further trial data comes through.
5. What is the efficacy difference between live vaccine and non-live” vaccine.
   Live vaccines can be dangerous for immunosuppressed patients like transplant patients, but all the COVID-19 vaccines planned for Australia are not live vaccines.
6. Will children under 16yrs who are tx recipients be getting the vaccine.
   When enough study has been done on children and it is approved by the Therapeutic Goods Administration of Australia
7. Will parents and carers of under 16 transpant patients be elligible for the vaccine before the general public, considering that the child can’t get it until they turn 16?
   Because children (even immunosuppressed children) have low rates of serious COVID-19 infection, contacts of immunosuppressed children are not planned to move up the queue at the moment.
8. Will the vaccine be as effective for those who have recently had a kidney transplant -less than 6 months, higher dose of pred and other immunosuppressive meds.
   The immunosuppression is at the highest level initially after transplant when vaccine response may not be quite as good, so we will likely suggest waiting about 3 months after transplant to get vaccinated. Formal advice should be out soon.
9. Does vaccination increase antibodies in the event you need another transplant in the future(god forbid). this would be general to vaccine not just the covid.
   The antibodies produced from the vaccine are specific against COVID and not against organs, so we do not expect these antibodies to cause problems with organ rejection, and our experience with other vaccines suggests they are safe in this regard.
10. Will my 16 yo daughter with KT be in group 1b or group 5?
    Age 16 or over is the approval for the Pfizer vaccine, so we would think phase 1b.
11. Should family members who may become living donors have the same vaccine?
    Living donors or family members may have a different vaccine to a patient with a transplant but there is no problem with this.
12. What can we do to protect children while we wait for a vaccine to be approved for them?
    Continue measures to reduce exposure to COVID-19 and vaccinate family and other close contacts when this opportunity comes up.
13. Is it important for close adult family and friends of transplanted children to get vaccinated?
    Because this provides a “ring” of protection around the child, as close contacts are the most likely to transmit the virus to the child.
14. Will my child get a choice of vaccine when vaccines have been approved for children?
    We are not sure at this stage, though like adults we suspect not. It will depend on vaccine trial data and supplies of vaccines in Australia.
15. Will there be any risk of rejection with the vaccine?
    We are waiting for further data but the vaccines are not expected to cause rejection and have not done so far. The benefits in preventing infection outweigh potential risks and we suggest all transplant and immunocompromised patients are vaccinated.
16. Will the immunosuppression affect my child’s response to the vaccine?
    We are awaiting more data. Although vaccine responses with immunosuppression are often a little lower than other individuals, we still expect the COVID-19 vaccines to be effective.
17. When the vaccine is approved for children, will my child be offered immediate access, or do we need to wait for more data in immunosuppressed children?
    We expect when COVID-19 vaccines are approved for children generally that immunosuppressed children should also be vaccinated even if there limited data specific for immunosuppressed children. The vaccines are not live. We do not expect different side effects in immunosuppressed children.

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