Vaccination and their importance for lung transplant recipients in a COVID-19 world

Abstract

Introduction: Lung transplant patients are immunocompromised because of the medication they receive to prevent rejection, and as a consequence are susceptible to (respiratory) infections. Adequate vaccination strategies, including COVID-19 vaccination, are therefore needed to minimize infection risks.Areas covered: The international vaccination guidelines for lung transplant patients are reviewed, including the data on immunogenicity and effectivity of the vaccines. The impact on response to vaccination of the various categories of immunosuppressive drugs, used in the posttransplant period, on response to vaccination is described. A number of immunosuppressive and/or anti-inflammatory drugs also is used for controlling the immunopathology of severe COVID-19. Current available COVID-19 vaccines, both mRNA or adenovirus based are recommended for lung transplant patients. Expert opinion:In order to improve survival and quality of life, infections of lung transplant patients should be prevented by vaccination. When possible, vaccination should start already during the pre-transplantation period when the patient is on the waiting list. Booster vaccinations should be given post-transplantation, but only when immunosuppression has been tapered. Vaccine design based on mRNA technology could allow the design of an array of vaccines against other respiratory viruses, offering a better protection for lung transplant patients.

Vaccination Against SARS-CoV-2 in Lung Transplant Recipients: Immunogenicity, Efficacy and Safety

“…Vaccination against COVID-19 is an essential step in the prevention of severe COVID-19 infection in LuTx recipients ( 28 ). Currently, LuTx candidates are recommended to undergo vaccination while on the transplant waiting list ( 5 , 21 ). These recommendations stem from the fact that the COVID-19 vaccine immunogenicity, efficacy and safety were shown to be greater in the pre-transplant patients as compared to the SOT recipients ( 5 , 8 , 35 ).…”

“…It has been already demonstrated that patients that were vaccinated while on the transplant waiting list were able to mount much higher anti-SARS-CoV-2 immune responses as compared to patients that were vaccinated after the transplantation ( 5 , 21 ).…”

“…Since there are currently only limited data on the efficacy, immunogenicity and safety of the third dose of anti-COVID-19 vaccine in LuTx recipients, promising results demonstrated by Peled et al. may further promote attempts to evaluate these outcomes in individuals after lung transplantation ( 21 ). In this study, the humoral response increased from 23% to 67% after the third dose of the BNT162b2 vaccine in heart transplant recipients ( 33 ).…”

“…Previous experiences with influenza vaccination in LuTx recipients reported pre-transplant patients being able to mount a more vigorous immune response as compared to LuTx recipients ( 20 ). Similarly, COVID-19 vaccination is currently recommended primarily in waitlisted patients to achieve a stronger humoral and cellular immune response ( 21 ). Even-thought the re-exposure may sustain protective antibodies, it is yet to be clarified which factors have affect the adaptive immune responses ( 15 ).…”

COVID-19 Vaccination in Lung Transplant Recipients

“…Transplant patients are immunosuppressed and at increased risk of morbidity and mortality related to infection as compared to the immunocompetent population. This increased risk profile also holds true for coronavirus disease 2019 (COVID-19) infection [ 1 – 4 ]. Vaccination is an important strategy to prevent post-transplant complications.…”