Who gets organ transplants first?

Transplant Center Munich of the LMU

COVID-19: Information for Patients

Important information for you during the corona pandemic: To protect the rest of the patients, please do not come to the transplant center if you are suspected of having a COVID-19 infection!

News about the Covid-19 vaccination

After the introduction of the COVID-19 vaccination in Germany, we received many inquiries as to whether and which vaccination should be carried out for patients on the waiting list for organ transplantation and for organ transplant patients. It is currently not possible to make a statement on this based on scientific data, as transplant recipients were excluded from the recently conducted SARS-CoV-2 vaccine trials. For this patient population, unfortunately, neither efficacy, duration of protection, nor safety are known. The recommendations for patients after organ transplantation are therefore based primarily on our extensive experience with established vaccinations (e.g. the flu vaccination). In addition, general information about vaccinations is available at www.corona-schutzimichtung.de, including the consent form, the information sheet, as well as guidelines and a newsletter information service. In the following we want to address some frequently asked questions:

What are the rights of transplant patients to a vaccination:
According to the "Ordinance on the right to vaccination against the SARS-CoV-2 coronavirus" of the Federal Ministry of Health, organ transplant patients fall into the second highest risk category (vaccinations with high priority) after those over 80 years of age. Therefore, after an organ transplant, patients have the option of preferring to be vaccinated against SARS-CoV-2.

Do we recommend a COVID-19 vaccination to our transplant patients?
Possible concerns about the available SARS-CoV-2 vaccines include the lack of long-term safety data, a possible reduction in efficacy in immunocompromised patients, the unknown persistence of the immune response, and the possibility of vaccine-related rejection. Based on our experience and the extensive studies regarding the administration of other vaccines, as well as in view of the risks associated with COVID-19 disease for patients after organ transplantation, we recommend vaccinating against COVID-19 as soon as possible in all patients with an uncomplicated course to let. As a rule, these are patients with normal, not increased immunosuppression and a low incidence of rejection. All other patients should consult their doctor at the transplant center. You can of course also do this if you are unsure whether you fall under the category of "uncomplicated course".

Which vaccination is suitable for patients after organ transplantation?
The recently approved mRNA SARS-CoV-2 vaccines (BioNTech / Pfizer, Moderna) use synthetic mRNA that is transported into cells by lipid nanoparticles. The non-infectious viral spike proteins of the coronavirus are produced against which a desired specific immune response is then triggered. According to all previous experience, concerns are not justified: the mRNA does not replicate, does not integrate into the human genome and is broken down after translation. According to the current status, these vaccines should therefore not pose a problem for patients on the waiting list or after organ transplantation.

Possible concerns about the new viral vector vaccines (AstraZeneca / University of Oxford) have centered on an out-of-control viral infection, especially when the host is immunocompromised. These concerns also have no scientific basis: current adenoviral vaccines contain a non-replicating virus; this platform has been used for gene therapy for rare diseases and cancer for decades. Other vaccines currently under investigation include inactivated vaccines against viruses and protein subunits; Similar vaccines have been used in transplant recipients for other infections, including hepatitis A and B viruses, pertussis, and human papillomavirus. The potential contraindication of live attenuated vaccines is not relevant for SARS-CoV-2, as there are currently no such SARS-CoV-2 vaccines. Such vaccines would only be considered for non-immunocompromised pre-transplant patients who are in stable condition on the waiting list. In summary, there is currently no preference for any particular vaccine in relation to transplant patients, you should definitely (if you are in a stable condition) accept any vaccination appointment offered to you, regardless of the vaccine available.

When should organ transplant patients be vaccinated?
The effectiveness of the vaccination in immunocompromised patients could be impaired by the suppressed function of the immune system. In the first six months after organ transplantation in particular, the immunosuppression is usually higher than in the later course. Therefore, at this early stage, patients should always consult the doctors treating them at the transplant center first
they get vaccinated. All other patients with stable disease should get vaccinated as soon as possible.

Is there a risk for the transplant with the COVID-19 vaccination?
After organ transplantation, analogous to other vaccinations (e.g. the flu vaccination), we do not assume an increased risk of organ rejection due to an excessive general immune reaction, since the vaccine is very specific for SARS-COV-2.

Should patients on the organ transplant waiting list be vaccinated?
Patients on the waiting list should be vaccinated as soon as possible, as they are usually not yet under medicinal immunosuppression. It can therefore be assumed that the vaccine response will be better compared to the time after the organ transplant, especially since no vaccination should be given in the first 6 months (see above). The chances of a transplant are not affected by a COVID-19 vaccination.

What about the entitlement for patients on the waiting list:
These are not explicitly named in the vaccination ordinance. We recommend applying for a prioritization comparable to that of transplant recipients when registering for a vaccination.

Can patients be vaccinated at the transplant center?
Please understand that a COVID-19 vaccination cannot currently take place in our center / clinic. Due to the complex transport logistics and the currently very limited vaccine resources allocated according to specified criteria, we have no way of procuring vaccines for patients. You must register at the vaccination centers provided for this purpose. Should that change, we will inform you immediately.

News about consultation hours / transplants

Due to the coronavirus pandemic, we have to adapt the consultation hours for our patients to the hospital's current requirements for infection protection. It goes without saying that we continue to guarantee adequate care for all of our patients.
If you have an appointment with us, please do not enter the transplant center immediately after arrival, but wait in the area in front of it until an employee comes to you. She will then give you a questionnaire that will help us assess whether you are at risk of Covid-19 infection. In addition, she will determine your body temperature using an ear probe. You can only enter the center if the employee asks you to do so. Due to the limited space, we also ask you to refrain from bringing accompanying persons to the center, unless you are dependent on their help and support. We ask for your understanding for these measures to protect our employees, but above all for your protection and that of your fellow patients.

Prepare for the waiting list
The consultation hours or the information talks for patients who are being prepared for inclusion on the waiting list for a transplant will continue to be carried out if the listing appears to be very urgent due to the underlying disease. You're welcome
Send us the results of any pending investigations so that the preparation for listing can continue internally regardless of your visit.

Living kidney donation
The living kidney donation program is currently being continued. Patients will be informed immediately as soon as anything changes in this regard.

Patients on the waiting list
Patients who are already on the waiting list are called in if an update of the patient status that is essential for the continuation of the listing has to be carried out. As far as possible, we replace other routine appointments with telephone contacts. Please inform us immediately if something has changed in your disease status, including, of course, a suspected or actual confirmation of an infection with the Corona Virus.

Organ transplants
If Eurotransplant offers a suitable organ for a patient on our waiting list, we will continue to carry out the corresponding transplant provided the recipient is in a transplantable state. So far, there is no evidence that transplants are currently a greater risk for recipients.

Transplant follow-up
The consultation hours in the transplant clinic for patients who have already been transplanted will be reduced and will mainly take place for urgent patients who cannot be moved. These are in particular freshly transplanted patients (<6 months after Tx) or patients with acute complications. Routine examinations such as annual follow-up examinations will be postponed as far as possible.

We will keep in touch by telephone with the patients who we do not call in or who cancel those patients who have already been arranged. If necessary, we also offer a telephone consultation for medical problems that arise at short notice. We will keep you informed about current developments / changes here on our website.