Extra COVID-19 vaccine may help protect transplant patients

Alma Sevilla preparers a vial of COVID-19 vaccine. An extra dose could give some organ transplant patients the
Alma Sevilla preparers a vial of COVID-19 vaccine. An extra dose could give some organ transplant patients a needed boost, a new study finds.
(Irfan Khan / Los Angeles Times)

A small study offers the first hint that an extra dose of COVID-19 vaccine might give some organ transplant recipients a boost in protection.

Even as most vaccinated people celebrate a return to near normalcy, millions who take immune-suppressing medicines because of transplants, cancer or other disorders remain in limbo — uncertain as to how protected they are against the coronavirus. It’s simply harder for vaccines to rev up a weak immune system.

The study published Monday tracked just 30 transplant patients, but it’s an important step toward learning if booster doses could help.

Of the 24 patients who appeared to have no protection after the routine two COVID-19 vaccinations, eight developed virus-fighting antibodies after an extra shot, researchers from Johns Hopkins University reported in Annals of Internal Medicine. And six others who’d had only minimal antibodies got a big boost from the third dose.

“It’s very encouraging,” said Dr. Dorry Segev, a Hopkins transplant surgeon who helped lead the research. “Just because you’re fully negative after two doses doesn’t mean that there’s no hope.”

Working with the National Institutes of Health, Segev’s team hopes to begin a more rigorous test of a third vaccination in 200 transplant recipients this summer.

Immune-suppressing drugs prevent rejection of transplant patients’ new organs but leave them extremely vulnerable to the coronavirus. Transplant patients were excluded from initial testing of COVID-19 vaccines, but doctors urge that they get vaccinated in hopes of at least some protection.


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There is some benefit. The Hopkins team tested more than 650 transplant recipients and found that about 54% harbored virus-fighting antibodies after receiving two doses of the Pfizer-BioNTech or Moderna vaccines — although generally fewer than in otherwise healthy vaccinated people.

Protection against COVID-19 is also a concern for those with autoimmune disorders. One study of patients with rheumatoid arthritis, lupus and other autoimmune disorders found that 85% developed antibodies, said Dr. Alfred Kim of Washington University in St. Louis. But those who used certain immune-suppressing drugs produced dramatically lower levels, a cause for concern.

“We tell our patients to act like the vaccine is not going to work as well as it does for their family and friends,” said Kim, who would like to test a third dose in autoimmune patients. “This is very frustrating news to them.”

Guidelines issued in France recommend a third COVID-19 shot for certain severely immune-suppressed people, including transplant recipients, Segev noted.

Doctors sometimes give extra doses of other vaccines, such as the hepatitis B shot, to people with weak immune systems.

The U.S. hasn’t authorized extra COVID-19 vaccinations. But around the country, immune-compromised patients are seeking third doses on their own; those are the people Hopkins sought to test.

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In San Francisco, Gillian Ladd agreed to blood tests before and after receiving an extra dose. The transplant recipient of a kidney and pancreas, Ladd, 48, was terrified to leave her house after learning she had no measurable COVID-19 antibodies, despite two Pfizer shots.

With the additional dose, she said, “I had gotten what I needed in order to survive,” but she’s sticking with masks and other precautions.

“I am being as careful as I possibly can while acknowledging that I’m coming back into the world of the living,” she said.

Additional research is needed to tell if a third dose really helps, who are the best candidates and if different brands of vaccine offer different benefits — plus whether the extra immune stimulation could increase the risk of organ rejection.

Segev notes that in addition to antibodies, vaccinations normally spur protections such as T-cells that can fend off severe illness. He and other research groups are testing whether immune-compromised patients get that benefit.

But for now, said Washington University’s Kim, “the best way to protect these people is for others to get vaccinated.”