Kidney Transplant Recipient talking to doctor

People who’ve had a kidney transplant need to take medication to prevent their body from rejecting their new kidney. This medication weakens their immune system a little so that it doesn’t attack the new organ.

But a weakened immune system means it’s also harder for transplant recipients to fight off infections. That’s why people who have had organ transplants have a higher risk of severe disease from COVID-19. They’re also more likely to end up in the hospital from COVID-19.

That means it’s especially important for transplant recipients to get a COVID-19 vaccine. But the medications to prevent organ rejection also affect how well your body responds to vaccines. A weakened immune system means transplant recipients may not build immunity against disease as well as other people do.

It’s still important to get the vaccine because every bit of extra protection helps. Experts created vaccine guidelines to help transplant recipients get the most protection possible. Public health experts also recommend masking and social distancing for additional protection.

How Many COVID-19 Vaccine Doses Do I Need?

To be considered fully vaccinated with an mRNA vaccine, people typically need to have two doses of the Pfizer or Moderna vaccine. However, the immune systems of kidney transplant recipients may react differently to the vaccine. Transplant recipients who’ve had two mRNA vaccines may have less protection against COVID-19 than other people. That’s why the CDC recommends an extra dose for all organ transplant recipients who’ve received two mRNA COVID-19 vaccines.

This means you should get a total of three mRNA vaccine doses as part of your initial protocol, rather than the typical two. You should wait four weeks after the second dose before getting the third dose. You should also wait at least one month after your transplant before getting the extra dose.

Which Brand of Vaccine Should I Get for My Third Dose?

Transplant recipients who received two doses of the Pfizer or Moderna mRNA vaccine should get a third dose of the same vaccine. If the vaccine brand you originally got is not available or unknown, you can get a dose of either mRNA brand.

Do I Need a Booster Shot?

If you have received three doses of an mRNA vaccine, the CDC still recommends that you get a booster shot as well. You should receive the booster shot at least three months after your third vaccine dose.

You can choose any of the three COVID-19 vaccines authorized in the U.S. for your booster shot. Your booster can be from Pfizer, Moderna, or Johnson & Johnson (J&J). Right now, it’s not clear if getting a different brand is more effective than getting the same brand.

Again, wait at least one month after a transplant before getting a booster.

What If I Got the J&J vaccine?

If you received the Johnson & Johnson vaccine, the CDC doesn’t currently recommend that you get an additional J&J shot. But the CDC does recommend all J&J recipients who are transplant recipients get a second vaccine dose with either the Pfizer or Moderna mRNA vaccine at least one month from the J&J dose.

You should get the booster shot at least two months after your second dose. But wait at least one month after your transplant before getting the booster dose.

Concerned about only having one dose of the J&J vaccine and one dose of an mRNA vaccine (rather than three doses of an mRNA) before your booster? Talk to your doctor about your concerns.

I’m on the Kidney Transplant Waiting List. Can I Get an Additional Dose?

The CDC recommends extra doses for people who have moderate or severe immunosuppression. Whether you have a severely weakened immune system depends on your condition and the medication you’re taking. The CDC provides a list of people who should receive an extra vaccine dose.

You should speak to your doctor about whether you qualify to receive the extra vaccine dose. Even if you don’t, you should still get a booster shot at least five months after your second dose. If you get a kidney transplant before you need a booster, wait one month after your transplant to get the booster.

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Do I Need to Show Proof That I’m a Transplant Recipient?

You shouldn’t need to show proof that you are a transplant recipient to receive an extra dose of a COVID-19 vaccine. Anyone with a severely weakened immune system can get an additional dose without showing proof of their condition.

The place administering your vaccine may ask you for an insurance card. If you have an insurance card, you may provide it. If you don’t have insurance, you can still receive the vaccine and don’t need to show an insurance card.

Someone in My Household is a Transplant Recipient. Should I Get an Additional Vaccine Dose?

You don’t need to get an extra vaccine dose if you don’t have a weakened immune system. The CDC only recommends an extra dose to people who have moderately or severely compromised immune systems.

But it is important for all household members of a transplant recipient to get fully vaccinated. If it has been at least five months since your second dose, you should also get a booster shot. This reduces your chances of having a breakthrough infection and protects vulnerable loved ones.

Is the COVID-19 Vaccine Safe for Kidney Transplant Recipients?

Studies have shown that COVID-19 vaccines are safe for kidney transplant recipients. People who have had a kidney transplant do not experience any more side effects than others who get the vaccine.

Studies have also shown that transplant recipients have not had a higher risk of serious side effects after a third vaccine dose. In research of transplant recipients who received an extra dose, no organ rejection occurred.

What Side Effects Should I Expect from an Extra Dose or a Booster Shot?

The side effects from third doses and booster doses appear similar to the side effects seen after the first or second doses. Some people have fewer side effects after the third or booster dose than after the second dose.

The most common side effects are pain at the injection site and feeling tired. Other possible side effects include fever, chills, headache, nausea, muscle pain, and joint pain. If you have more serious health problems after getting the vaccine, contact your healthcare provider to let them know.

Is it Safe for Me to Go to a Holiday Family Gathering if I am a Transplant Recipient?

Transplant recipients may not have complete protection against COVID-19 even after three doses of a vaccine. That means everyone around them also needs to be fully vaccinated and boosted if it has been at least five months since they completed the vaccine series. If everyone at a holiday family gathering is fully vaccinated and boosted, then the risk of infection for transplant recipients is very low.

Fully vaccinated means someone received a second mRNA vaccine dose or a J&J vaccine at least two weeks before gathering. Individuals who received the two doses of mRNA vaccine more than five months ago, or who received a dose of the J&J vaccine more than two months ago, should receive a booster. If some people at the gathering are not fully vaccinated or boosted, the risk of infection for transplant recipients is higher. That includes children who may be too young for vaccination.

The CDC doesn’t currently recommend COVID-19 testing if someone does not have symptoms. But for extra protection, you can ask family members to do an at-home rapid test before coming to your holiday gathering.

Should I Wear a Mask at Family Gatherings?

It is safest for you to wear a mask at any gathering of people outside your household, especially if some aren’t fully vaccinated. Anyone at the gathering who is not fully vaccinated should wear a mask.

The more people who wear masks, the lower the risk of infection is for everyone, including transplant recipients. The lowest risk situation would involve everyone wearing a mask except when eating or drinking. But even if not everyone wants to wear a mask, it’s most important for unvaccinated people to wear one.

Sources

COVID-19 Vaccine Booster Shots. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. Centers for Disease Control and Prevention. Link

COVID-19 Vaccines for Moderately to Severely Immunocompromised People. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. Centers for Disease Control and Prevention. Link

Holiday Celebrations. Safer Ways to Celebrate Holidays. National Center for Immunization and Respiratory Diseases (NCIRD), Division of Viral Diseases. Centers for Disease Control and Prevention. Link

Nassim Kamar, Florence Abravanel, Olivier Marion, Chloé Couat, Jacques Izopet, and Arnaud Del Bello. Three Doses of an mRNA Covid-19 Vaccine in Solid-Organ Transplant Recipients. New England Journal of Medicine. August 12, 2021. Link

Sara Oliver. Data and clinical considerations for additional doses in immunocompromised people. ACIP Meeting. July 22, 2021. Centers for Disease Control and Prevention. Link

Sophie Caillard and Olivier Thaunat. COVID-19 vaccination in kidney transplant recipients. Nature Reviews Nephrology. September 27, 2021. Link

About Transplant Services

For more than four decades, UPMC Transplant Services has been a leader in organ transplantation. Our clinicians have performed more than 20,000 organ transplant procedures, making UPMC one of the foremost organ transplant centers in the world. We are home to some of the world’s foremost transplant experts and take on some of the most challenging cases. Through research, we have developed new therapies that provide our patients better outcomes — so organ recipients can enjoy better health with fewer restrictions. Above all, we are committed to providing compassionate, complete care that can change – and save – our patients’ lives. Visit our website to find a provider near you.