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6 Questions Organ Transplant Recipients May Have About COVID-19

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Posted by Nathaniel Marchetti, DO

For many people, the threat of COVID-19 no longer looms quite as large as it once did. But the virus still poses a significant threat to organ transplant recipients and others who are immunocompromised.

As restrictions ease and the general public takes fewer precautions, a number of my transplant patients ask what they should be doing to stay safe. They also want to know what to do if they get infected and whether there are treatment options available to help them avoid complications.

Here are some of the questions that come up most often and the answers I believe all transplant recipients should know.

What risks does COVID-19 pose for transplant patients?

People who have received a solid organ transplant or blood stem cell transplant are more likely to become very sick from COVID-19.

Taking anti-rejection medications can cause transplant recipients to have weakened immune systems, which can make it harder for them to fight off a COVID-19 infection. Transplant recipients and people with weaker immune systems don't receive as much protection from COVID-19 vaccination either (though it's still important to get immunized). Some transplant patients may also have co-existing medical problems that raise the risk for severe COVID-19, such as diabetes, high blood pressure, or kidney disease.

All of these factors can add up to a greater risk for complications that could require hospitalization, the need for intensive care, or the use of a ventilator. In some cases, these complications could even be deadly.

Do transplant patients need to do more to protect themselves against COVID-19?

Yes. While my patients are preparing for and recovering from a transplant, I make it a point to talk with them about the importance of minimizing their risk of contracting COVID-19. Being a transplant recipient doesn't guarantee that a patient will develop severe illness or complications, but it does greatly increase the chances. For that reason, it's crucial for transplant recipients to take appropriate precautions.

What can transplant patients do to protect themselves against COVID-19?

Even with COVID-19 restrictions easing and many people taking fewer precautions against the virus, I remind my transplant patients that it’s really important that they stay vigilant. Organ recipients should:

  • Get vaccinated and boosted if they haven’t already. Vaccines are the best form of protection against COVID-19. The latest evidence shows that patients will benefit from three primary doses of the vaccine (with the third given at least four weeks after the second dose) plus keeping up to date with the most recent booster shot. This applies to organ recipients who have undergone a transplant within the last two years or those who are currently taking immunosuppressants. Talk with your transplant care team if you have questions about getting vaccinated or whether you might benefit from a second booster shot.
  • Avoid close contact and crowded spaces. Limit your exposure to those outside of your household as much as possible, especially in indoor settings.
  • Wear a well-fitting mask. NIOSH-approved respirators, such as N95 masks, offer the highest level of protection when properly fitted. I always remind patients that even prior to the COVID pandemic we asked all lung transplant patients to wear a surgical mask when out of the house for at least the first year post-transplant.
  • Monitor your health daily. Pay close attention to how you're feeling, and report any possible COVID-19 symptoms to your transplant care team right away.
  • Wash your hands often. It protects against COVID-19 as well as other infections.
  • Continue taking your anti-rejection medications as prescribed. Cutting back on your dosage or stopping immunosuppressants before getting vaccinated is not recommended.

How can I tell if I have COVID-19?

COVID-19 can cause a wide variety of symptoms that usually begin within 2 to 14 days after exposure to the virus. When a person has a mild to moderate infection, they may experience cold- or flu-like symptoms, including

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea
  • Rash

In serious cases, COVID-19 can cause life-threatening symptoms that require emergency medical attention. These include:

  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion
  • Inability to wake up or stay awake
  • Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone

If you or someone you're caring for is experiencing these symptoms, call 911 right away.

When should I seek medical attention for COVID-19 symptoms?

I urge patients to call their transplant care team immediately if they're experiencing any possible symptoms of COVID-19, even if the symptoms are mild.

Because transplant recipients are at higher risk of getting seriously sick, seeking care sooner is always better. The faster symptoms are reported, the faster you can get tested and started on medications that can potentially reduce your chances for dangerous complications.

What treatments are available for transplant patients?

Though it's still crucial for patients to take steps to reduce their risk of getting COVID-19, we have good options that can support those efforts and lessen the chances of severe complications.

  • Paxlovid and Molnupiravir are oral medications that may reduce the risk of complications in transplant patients with COVID-19. These drugs are given in an outpatient setting.

I recommend that patients talk with their transplant care team about these options. There could also be new and emerging therapies to consider. Avoid taking any oral medications for COVID-19 unless they have been prescribed by your transplant team.

Is there anything transplant patients can do to cope with the stress of worrying about COVID-19?

Taking extra steps to stay safe can take a toll on transplant recipients' mental health, so I talk with my patients about employing a proactive approach. It can be helpful to engage in habits that support their well-being, such as eating healthy foods, exercising regularly, getting enough sleep, connecting with others, and making time to relax and unwind each day. Taking breaks from the news or social media can be calming as well.

If a patient is still struggling, they should reach out to their transplant team. Together, you can come up with a list of actionable steps that can help you feel better.

Learn more about transplants at Temple Health

The Transplant Program at Temple Health has a long and excellent history of helping thousands of patients receive much-needed transplants.

Nathaniel Marchetti, DO

Dr. Marchetti is a pulmonologist at the Temple Lung Center and Medical Director of the Respiratory Intensive Care Unit at Temple University Hospital. His clinical interests include Advanced lung disease, Chronic Obstructive Pulmonary Disease (COPD), Interstitial lung disease and Lung transplantation.

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