COVID vaccination before transplant

Posted by mmokc @mmokc, Jul 19, 2021

My husband is over 65, so he was able to get his Covid vaccination in early 2021 (Jan-Feb). At the time, he had just been listed for a liver transplant due to Primary Biliary Cirrhosis/Cholangitis. In April 2021, he received his new liver and is now on various anti-rejection immune suppression medications. My question is whether there is any information being collected on transplant recipients who were vaccinated BEFORE transplant; that is, does their immunity to Covid survive the transplant and the transplant medications? Everything I read about transplant patients and vaccines pertains to people with pre-Covid transplants who are now wondering if they derive any benefit from the vaccine. So the people I'm talking about would be a pretty small group: people vaccinated in early '21 and transplanted since then. There hasn't been much time to follow them, but perhaps more of them will be coming along, as transplant teams seem pretty busy lately. (I mean, while I'm on the topic: do pre-transplant vaccines for, e.g., shingles, flu, whooping cough, tetanus still protect you after transplant?)

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@mmokc Welcome to Mayo Clinic Connect! I see you have been a member for a time, but this is your first post.

Congratulations to your husband on his liver transplant! I hope he is feeling well, and back to his normal life. You ask a very interesting question. Have you posed this to his transplant team, or at least to his social worker associated with the team, to get their thoughts?
Ginger

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@gingerw

@mmokc Welcome to Mayo Clinic Connect! I see you have been a member for a time, but this is your first post.

Congratulations to your husband on his liver transplant! I hope he is feeling well, and back to his normal life. You ask a very interesting question. Have you posed this to his transplant team, or at least to his social worker associated with the team, to get their thoughts?
Ginger

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The team sort of says "we don't know yet," but they seem happy to hear that he had been vaccinated.

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@mmokc

The team sort of says "we don't know yet," but they seem happy to hear that he had been vaccinated.

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@mmokc HI and Welcome, I thought I would add that during a recent discussion with my Infectious Disease Doctor he mentioned that yes to be effective they are trying to get all pretransplant patients vaccinated prior to transplant before the immune suppressed drugs are on board. So that tells me they feel it still is effective after transplant. I hope that helps.
Blessings

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@danab

@mmokc HI and Welcome, I thought I would add that during a recent discussion with my Infectious Disease Doctor he mentioned that yes to be effective they are trying to get all pretransplant patients vaccinated prior to transplant before the immune suppressed drugs are on board. So that tells me they feel it still is effective after transplant. I hope that helps.
Blessings

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Would it be helpful to test for the covid-19 spike protein antibodies?

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@hello1234

Would it be helpful to test for the covid-19 spike protein antibodies?

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@hello1234 I would think it would be helpful to test for antibodies. My transplant was almost 5 years ago. My transplant team would not write a lab order for the antibody test but my PCP did and I do have antibodies which is somewhat reassuring. I think it would definitely be helpful to determine if the vaccine that was given prior to transplant has been affected by the immunosuppressants. My gut feeling is that the antibodies remain strong. I think that because we are not advised to get repeat vaccinations for other things that we may have had prior to transplant.
JK

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@contentandwell

@hello1234 I would think it would be helpful to test for antibodies. My transplant was almost 5 years ago. My transplant team would not write a lab order for the antibody test but my PCP did and I do have antibodies which is somewhat reassuring. I think it would definitely be helpful to determine if the vaccine that was given prior to transplant has been affected by the immunosuppressants. My gut feeling is that the antibodies remain strong. I think that because we are not advised to get repeat vaccinations for other things that we may have had prior to transplant.
JK

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Hi JK,
Congrats on your 5 year anniversary! Did you have a kidney or liver transplant? I am impressed that you developed covid-19 antibodies after only two doses of the vaccine! Which immune suppression drugs and doses are currently on? (I am a one year post kidney patient patient with zero covid antibodies after two doses of Moderna vaccine, looking forward to a third dose..fingers crossed!)

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@hello1234

Hi JK,
Congrats on your 5 year anniversary! Did you have a kidney or liver transplant? I am impressed that you developed covid-19 antibodies after only two doses of the vaccine! Which immune suppression drugs and doses are currently on? (I am a one year post kidney patient patient with zero covid antibodies after two doses of Moderna vaccine, looking forward to a third dose..fingers crossed!)

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@hello1234 I had a liver transplant. I wonder if the higher level of antibodies I developed could possibly be because I didn't test for them until about 6 weeks after my second shot. My antibody number was 13.83. Not the best, but definitely some protection.

I had the Pfizer vaccine. I take sirolimus, 2.5 mg once a day. I was taking prednisone also but they are trying me without that now. Hopefully, my numbers will continue to be good without it.
JK

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@contentandwell

@hello1234 I had a liver transplant. I wonder if the higher level of antibodies I developed could possibly be because I didn't test for them until about 6 weeks after my second shot. My antibody number was 13.83. Not the best, but definitely some protection.

I had the Pfizer vaccine. I take sirolimus, 2.5 mg once a day. I was taking prednisone also but they are trying me without that now. Hopefully, my numbers will continue to be good without it.
JK

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I am so happy to hear that you got some sort of immune response from the Pfizer vaccine and that your liver numbers are looking good without prednisone. I am wondering if certain immune suppression drugs allow for a stronger response than others . I take Cellcept and Envarsus XR. (I don't know if the John Hopkins study is analyzing down to that granular level.) Were you always on sirolimus or did you start out on Cellcept or tacronlimis? I am always curious to hear about everyone's journey!

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@hello1234

I am so happy to hear that you got some sort of immune response from the Pfizer vaccine and that your liver numbers are looking good without prednisone. I am wondering if certain immune suppression drugs allow for a stronger response than others . I take Cellcept and Envarsus XR. (I don't know if the John Hopkins study is analyzing down to that granular level.) Were you always on sirolimus or did you start out on Cellcept or tacronlimis? I am always curious to hear about everyone's journey!

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@hello1234 I started on tacrolimus but it was causing my creatinine to be high. They had me drinking 80-100 ounces of water a day to help with that but it didn't help enough so they changed me to sirolimus. I like that sirolimus is only once a day.
JK

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JK, It sounds like your current daily drug regimen is a DREAM…How wonderful! I love to hear from transplant patients five years in. Things are going well for me too. (I just had my one year anniversary) I am very happy to meet you.

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@hello1234

Would it be helpful to test for the covid-19 spike protein antibodies?

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We asked the transplant coordinator last week and they ordered an antibody test to be done along with his regular lab work this week, so we will see. I read on the news this morning that there's the possibility that CDC will recommend a 3rd dose of vaccine for the immuno-compromised. So…jury still out.

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