Global Liver Institute has consistently advocated for a more muscular and proactive set of solutions for transplant recipients, cancer patients, and individuals with compromised immune systems during the COVID-19 pandemic. Essential to this is strong leadership by our medical society partners. (See policy statement and letter to the transplant societies.)

On July 8, the American Society of Transplantation (AST), American Society of Transplant Surgeons (ASTS), and International Society for Heart and Lung Transplantation (ISHLT) released a statement, endorsed by a variety of other transplant organizations (listed below) on vaccine efficacy in organ transplant recipients.  We appreciate that they incorporated many of our requests for clarification in this updated statement, despite the incomplete and rapidly evolving evidence in this field. We also recognize that patients need to make decisions today to keep themselves safe while navigating living, working, and caring for their families.

Our summary of the key points from their statement (not verbatim):

  • Everyone should get vaccinated: Transplant candidates and recipients, eligible household members, close contacts of transplant recipients, and health care providers should be vaccinated to minimize risks to the recipient.
  • Vaccinate pre-transplant if you can. Ideally, vaccination should occur pre-transplant (with completion of vaccine series a minimum of two weeks prior to transplant).
  • Continue precautionary measures: Those with compromised immune systems should continue masking, hand washing, and social distancing.
  • There is not a consensus on the one best test to measure individual vaccine response: However, individual physicians and patients may decide that antibody testing is desirable following a discussion regarding the interpretation of the test results and the consequences/risks of acquiring COVID-19 infection.
    • There is still no clear test to determine vaccine effectiveness, and it remains unknown how protected transplant recipients are post-vaccination, including those who receive three doses. 
  • It is suggested that transplant recipients communicate with their transplant teams regarding booster vaccination recommendations and other medical decisions. Discuss with your doctor the best plan based on your conditions, medications, and the latest published literature. Consider the rates of COVID-19 infections and hospitalizations in your community when making a decision.

GLI concurs with the following call-to-action by AST, ASTS, and ISHLT:

“We STRONGLY urge funding agencies to invest in research evaluating vaccine immunogenicity, vaccine effectiveness, and strategies to enhance vaccine responses in vulnerable populations, including [solid organ transplant] candidates and recipients, who may fuel the perpetuation of the pandemic.” 

GLI expects future statements to strongly and clearly state the path towards:

  1. an active education and recruitment plan to include liver patients in vaccine effectiveness studies,
  2. prioritization of transplant patients for booster shots and their availability through transplant centers;
  3. collaboration on clinically meaningful immune response testing, and more information on, access to,
  4. and aggressive development of monoclonal antibodies and other COVID-19 treatments.

As always,  GLI stands prepared to partner to achieve all these goals in our shared mission of solving problems for people with liver diseases.

Other organizations signed on in support of AST, ASTS, and ISHLT statement:

  • The Transplantation Society (TTS)
  • Transplant Infectious Disease (TID)
  • International Pediatric Transplant Association (IPTA)
  • International Society of Vascularized Composite Allotransplantation
  • Intestinal Rehabilitation & Transplant Association
  • International Xenotransplantation Association (IXA)
  • International Society for Organ Donation and Procurement (ISODP)
  • Society of Pediatric Liver Transplantation (SPLIT)
  • Cell Transplant and Regenerative Medicine Society
  • International Pancreas & Islet Transplant Association (IPITA)
  • NATCO (The Organization for Donation and Transplant Professionals)
  • United Network for Organ Sharing (UNOS)
  • Canadian Society of Transplantation (CST/SCT)
  • European Society for Organ Transplant (ESOT)
  • American Society for Histocompatibility & Immunogenetics (ASHI)
  • International Transplant Nurses Society
  • Association of Organ Procurement Organizations (AOPO)
  • Pediatric Infectious Diseases Society (PIDS)