Transplant patients need 3 Covid-19 vaccine doses: Study

International study on 30 transplant patients who got a third booster shot leading to antibody response in eight of them sparks conversation among transplant doctors; fraternity calls for more research and trials

A recent study that suggests giving solid organ recipients three Covid-19 vaccine doses has triggered an active discussion in the transplant community. Doctors feel that booster doses should be considered for transplant patients if they have not mounted an immunological response.  

Dr Trupti Gilada, infectious disease physician at Masina Hospital said the entire discussion started after a retrospective study where 30 odd transplant patients volunteered to take a third dose of the Covid-19 vaccine after they found that they didn’t develop any antibodies post two doses. “They later offered blood samples for research. Out of which, eight did develop certain antibodies. It is definitely encouraging for the population whose immunity is lower and where two doses might not be enough in comparison to a normal person. There is a larger study in France. We are waiting for the results,” Gilada said, adding that meanwhile, transplant patients are being advised to take vaccines when their immunity is not at the lowest.

While the antibody response after two doses of the Covid-19 vaccine has been excellent in the general population, doctors treating transplant patients have been worried as most of their patients have shown low or no antibody response.

Dr Hemal Shah, nephrologist, Saifee Hospital, said renal transplant patients have suffered significantly due to Covid-19 in terms of morbidity and mortality. “In India, these patients were given priority for vaccination. Unfortunately, all five of my patients, when tested, failed to elicit an antibody response with two doses. I stopped recommending the test to avoid panic,” Dr Shah said. He said recent studies recommending an additional dose have given hope. Dr Zaheer Virani, a nephrologist from Prince Aly Khan Hospital, said immunocompromised individuals like solid organ recipients should be evaluated for an immunological response post-vaccination.

“If they fail to mount an immune response, a booster dose of the same vaccine or a vaccine based on another platform should be considered under a research trial,” he added.

Request to govt soon

Dr Zainulabed Hamdulay, heart transplant surgeon at Masina Hospital, said the transplant community and hospitals having transplant programs will soon be requesting the government for the booster dose for this population. “Infectious disease experts and immunologists are working on all the aspects of if and when to give the third dose. Just two doses for immunocompromised transplant patients are not enough. Right now, we don’t have the third booster dose option in India. But we might begin soon. Hospitals running transplant programs are going to request the government for the same.”

Dr Om Shrivastav, infectious disease expert and a member of the state task force, agreed that there is an active discussion in the fraternity about the third dose. “There is an urgent need to evaluate and assess transplant patients regarding the third booster dose but it needs to be scientifically validated,” he said.    

Dr Somnath Chattopadhyay, head of Hepatobiliary Surgery and Liver Transplant at Kokilaben Dhirubhai Ambani Hospital (KDAH), said more data is needed. “We all feel that yes, transplant patients might need the third booster dose. But what is the right time gap, we don’t know. Transplant patients’ immune system is a bit suppressed and the two doses might not launch the same immune response as a normal person,” he said.

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