Pre-Solid-Organ-Transplant COVID-19 Vaccination

Abstract

Vaccine such as influenza vaccine, is administered in stable transplant recipients, although live attenuated virus vaccines are contraindicated, generally due to risk of disseminated infection [1, 2]. Neither efficacy, safety, nor durability are well known in transplant recipients due to exclusion of them from recent COVID-19 vaccine trials [1, 2]. Currently, there are no SARS-CoV-2 vaccine platforms using attenuated live virus approved in phase III trials. Nevertheless, if they are approved for use, concerns, including potential decrease in efficacy in immunocompromised patients, potential for vaccine-related allograft rejection, unknown durability of the immune response, and long-term safety data still exist. Due to experience with neither the influenza vaccine nor the adjuvant recombinant zoster vaccine having been related to allograft rejection, successful administration of influenza and adjuvanted recombinant zoster vaccines to stable transplant recipients, and unanticipated vaccine-related adverse events to the allograft having not borne out, the influenza and adjuvanted recombinant zoster vaccines are able to be extrapolated to COVID-19 vaccines [2, 3]. In immunocompromised host, concerns for adenoviral vector vaccines are focused on a viral infection, but these concerns have no scientific evidence. Although newly approved adenoviral-vector use for vaccination, this vaccine platform has been used for decades for gene therapy for cancer and other rare diseases. Inactivated virus and protein subunit vaccine platforms that have been used in transplant recipients for other infections, such as human papilloma virus, pertussis, and hepatitis A and B, are currently under investigation for SARS-CoV-2 (COVID-19) infection in transplant recipients [2].