Vaccine safe for transplant recipient

Dear Dr. Roach: Iaman organ transplant recipient who has received both COVID vaccinations and both boosters, but I am wondering if I did the right thing.

I take immunosuppressants to keep my body from producing antibodies that would attack my donor kidney. Unfortunately, immunosuppressants effect my entire immune system, making me highly vulnerable to viruses, bacteria, etc. I am afraid that by stimulating my body to produce an antibody to the COVID virus, it will boost my immune system to produce antibodies that might attack my new kidney.

Am I in a Catch-22 situation?

G.K.

Answer: I understand why you are concerned, but the COVID vaccine stimulates your immune system to make only the antibodies directed against the COVID spike protein. These antibodies are precise and do not react to the donor kidney or your own body. Many people in your situation have gotten the vaccines and have not had any rejection. You did the right thing.

People with autoimmune disease also ask a similar question: Will the increase in immune system activity cause my autoimmune disease to flare? This has proven to be more of a theoretical concern than a real one, with no more flares after vaccination reported than would be expected without one, in people with multiple sclerosis and other autoimmune diseases.

Because of the immunosuppressive medicines necessary to prevent rejection of a transplanted kidney, organ recipients are indeed at higher risk of infection, so the COVID vaccine (as well as vaccines against other infections) are particularly important.

Some people who are unable to make antibodies because of an immune system disease or medication that suppresses this ability are at high risk. Those patients may want to consider tixagevimab and cilgavimab (Evusheld). This provides approximately six months of protection against COVID infection, reducing symptomatic infection rates by almost 80%. Many people who would benefit from this don’t know about it. If you do get COVID despite preventive medication, you should get treatment.