Questions About the COVID Vaccine and Transplantation

The University of Maryland Medical Center understands that transplant patients — both those already transplanted and those awaiting one — have specific questions related to the COVID-19 vaccine.

We compiled your questions and our experts answer them.

Should transplant patients get vaccinated?

Yes. We encourage transplant recipients to get the COVID-19 vaccine when possible.

What COVID-19 vaccines are currently available for transplant patients?

Transplant patients can get any of the currently available vaccines. Please see our COVID Vaccine Comparison page to learn more about the vaccines available.

Can I get COVID-19 from the vaccine?

No. You cannot get COVID from the vaccine. That is a myth. For more information on vaccine safety, see COVID Vaccine Facts and Myths.

What should UMMS transplant patients know about getting a third dose of the COVID-19 vaccination approved for immunocompromised people by the FDA and CDC?

Following their review of the emerging data, both the Food and Drug Administration and the Centers for Disease Control approved third doses of mRNA vaccines (Pfizer and Moderna) in transplant recipients who have completed their primary vaccine series.

Below is the University of Maryland Medical Center Transplant Center’s statement in response to the revised Emergency Use Authorization for COVID-19, including modifications to COVID-19 vaccine guideline for transplant recipients:

• Any solid organ transplant recipient 18 years of age or older who has received two doses of COVID-19 mRNA vaccine can receive a third dose of mRNA vaccine 28 days or more after completing their primary vaccine series.
• Every attempt should be made to match the additional mRNA vaccine dose to the primary mRNA vaccine series. If this is not possible, then a different mRNA vaccine can be substituted.
• Patients can schedule an additional dose of vaccine at their local pharmacy. They do not require a prescription from a healthcare provider.
• Antibody testing does not need to be performed prior to administering a third dose of COVID-19 vaccine.
• There are no updates to the Emergency Use Authorization for the Johnson & Johnson (J&J) COVID-19 vaccine. Additional doses of J&J vaccine are not recommended at this time for individuals who received J&J COVID-19 vaccine. Administration of an additional mRNA vaccine in individuals who received J&J as their primary vaccine series is not recommended at this time.
• Published data suggest that additional doses are safe in transplant patients. None developed serious side effects from additional doses of mRNA vaccines. Symptoms reported were similar to previous doses. There is no evidence of an increased risk of rejection attributable to the vaccine.
• Despite an additional dose of mRNA vaccine, some transplant recipients will still have a poor response to vaccination.
• Solid organ transplant recipients that receive an additional dose of mRNA COVID-19 vaccine should continue to practice social distancing and should continue to wear masks when out in public.

Is it okay for transplant patients to get two different vaccines?

Until we know more, different COVID-19 vaccines should not be given to the same person. This is also true for third doses of COVID-19 mRNA vaccines (see above). Every effort should be made to ensure that the additional COVID-19 mRNA vaccine dose is the same as the first two doses.

Are side effects of COVID-19 vaccines different in transplant patients?

Transplant patients were not a part of early vaccine studies. Early data suggest that transplant patients who get the vaccine are not at a higher risk of rejection or other problems. We think the risk of rejection is low.

In a recent study of 741 transplant patients who received both doses of mRNA vaccines, none had severe side effects. In this study, three out of four patients reported pain at the injection site. About 4 out of 10 patients had headache or fatigue. These symptoms improved after 24-48 hours. Only 1 patient developed acute rejection after the COVID-19 vaccination. There were no reports of neurologic complications or severe allergic reactions in this group.

While we do not have any data on the safety of the Johnson & Johnson vaccine in transplant recipients, we believe it is safer to get this vaccine than to risk becoming infected with COVID-19 while waiting for other vaccines.

Please see the Food and Drug Administration EUA Fact Sheets for each vaccine for more information about side effects.

• Pfizer Fact Sheet
• Moderna Fact Sheet
• Johnson & Johnson Fact Sheet

How well do the vaccines work in transplant patients?

These vaccines work less well in transplant patients than in healthy people. We expect this because transplant medicines weaken the immune system. We also expect this because it happens with other vaccines (for example, the flu shot).

There are two ways to find out how well a vaccine works. The best way is to measure the number of infections and deaths after the vaccine. Reports evaluating vaccine breakthrough infections in solid organ transplant recipients show that vaccine decreases risk for infection and of severe disease. However, rates of vaccine breakthrough infection are higher in transplant recipients than in the general population.

One recent study identified 151 vaccine breakthrough infections among 18,215 vaccinated solid organ transplant recipients. This means the risk of infection after COVID-19 vaccination is less than 1 percent. In another study, fully vaccinated transplant recipients had a lower risk of dying from COVID-19 infection (7.7 percent) compared to unvaccinated transplant recipients (12.6 percent). This is a 40 percent decrease in risk of dying.

The other way to find out how well a vaccine works is to measure antibodies. Antibodies are made by the immune system. A blood test can measure antibodies after vaccination. We assume that having a high amount of antibodies protects against infection. We do not know how much antibody is needed to protect people from severe infection or death from COVID-19.

After getting COVID-19 vaccines, about half (35 to 55 percent) of all transplant patients make antibodies. Transplant patients make fewer antibodies than healthy people.

Even if there are no antibodies, the vaccine may still protect from severe infection. This is because the vaccine teaches other parts of the immune system to fight the virus. Despite low antibody levels, the COVID-19 infection rate in vaccinated transplant patients is low.

Should transplant patients get antibody testing after receiving COVID-19 vaccination?

No. We do not recommend checking antibody levels after your COVID-19 vaccination.

Antibody testing is approved to see if there is a COVID-19 infection. There is no approved test to know if you have enough protection after the vaccine. We do not know how much antibody is needed to protect from COVID-19 infection.

People may be protected against severe COVID-19 infection without any antibodies.

Learn more about the types of COVID testing available.

Will I still have to wear a mask and keep my distance after I get the vaccine?

Yes. As a transplant patient, you should be more careful than everyone else even if you are fully vaccinated or have received an additional dose of COVID-19 mRNA vaccine.

You should still wear a mask. You should still practice social distancing. You should avoid large crowds. You should wash your hands often. These things are especially important in public or at work. Keep doing all these things if you are around anyone who may not be fully vaccinated.

Once you are fully vaccinated, you may meet with a few close friends or family members, IF they are also fully vaccinated. This can happen outdoors or indoors. In these small settings, you may relax a little about masking or distancing.

As a transplant patient, which vaccine should I get?

All three vaccines are quite safe, even for transplant patients. Overall, any vaccine is better than none. But if you have a choice, the Moderna and Pfizer vaccines may be slightly more effective in transplant patients than Johnson & Johnson.

Can transplant patients get the vaccine if they already had COVID-19?

Yes! And they should. We do not know how long people are protected from a second infection with COVID-19 after their first infection. There are cases of people becoming infected with COVID-19 for a second time. If you were infected with COVID-19, we recommend you get vaccinated once you have recovered from your initial infection. Talk with your doctor about how long to wait for vaccination once you have recovered.

Are there any COVID-19 vaccine trials for transplant patients?

Yes. If you are interested, visit our clinical trials for transplants page. You can also ask your transplant provider about any additional trials. You do NOT have to be in a research study to get the COVID-19 vaccine.

When should transplant patients get vaccinated?

If you are on the transplant waitlist it is better to complete the vaccine series before your transplant. You should talk about vaccination timing with your transplant team.

If you had a transplant, we recommend waiting at least two months after surgery before getting the vaccine. In some cases, you may need to wait at least three months after your transplant surgery before getting the vaccine. You should talk about vaccination timing with your transplant team.