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Feldman AG, Beaty B, Everitt M, Goebel J, Kempe A, Pratscher L, Danziger-Isakov LA. Survey of pediatric transplant center practices regarding COVID-19 vaccine mandates for transplant candidates and living donors and use of COVID-19-positive deceased organs. Pediatr Transplant 2023; 27:e14513. [PMID: 36939212 PMCID: PMC10509306 DOI: 10.1111/petr.14513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/27/2022] [Accepted: 11/28/2022] [Indexed: 03/21/2023]
Abstract
BACKGROUND COVID-19 vaccine is recommended for individuals ages ≥6 months; however, whether vaccination should be mandated for transplant candidates and living donors remains controversial. This study assessed COVID-19 policies at US pediatric solid organ transplant centers. METHODS A 79-item survey was emailed between March and April 2022 to 200 UNOS Medical Directors detailing center COVID-19 vaccine policies for transplant candidates and living donors and use of grafts from COVID-19-positive deceased donors. RESULTS The response rate was 77% (154/200). For children aged 5-15 years, 23% (35/154 centers) have a COVID-19 vaccine mandate, 27% (42/154) anticipate implementing a future mandate, and 47% (72/154) have not considered or do not anticipate implementing a mandate. For children ≥16 years, 32% (50/154 centers) have a COVID-19 vaccine mandate, 25% (39/154) anticipate implementing a future mandate, and 40% (62/154) have not considered or do not anticipate implementing a mandate. The top two reasons for not implementing a COVID-19 vaccine mandate were concerns about penalizing a child for their parent's decision and worsening inequities in transplant. Of 85 kidney and liver living donor centers, 32% (27/85) require vaccination of donors. Twenty percent (31/154) of centers accept organs from COVID-19-positive deceased donors. CONCLUSIONS There is great variation among pediatric SOT centers in both the implementation and details of COVID-19 vaccine mandates for candidates and living donors. To guide more uniform policies, further data are needed on COVID-19 disease, vaccine efficacy, and use of grafts from donors positive for COVID-19 in the pediatric transplant population.
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Affiliation(s)
- Amy G. Feldman
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric Liver Transplant Center, Digestive Health Institute, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Brenda Beaty
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Melanie Everitt
- Pediatric Heart Transplant Program, Section of Pediatric Cardiology, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | - Jens Goebel
- Pediatrics and Human Development, Section of Pediatric Nephrology, Helen DeVos Children’s Hospital, Michigan State University, Grand Rapids, Michigan, USA
| | - Allison Kempe
- Department of Pediatrics, Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado, USA
| | | | - Lara A. Danziger-Isakov
- Immunocompromised Host Infectious Disease, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
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Khazaaleh S, Alomari M, Sharma S, Kapila N, Zervos XB, Gonzalez AJ. COVID-19 in liver transplant patients: Impact and considerations. World J Transplant 2023; 13:1-9. [PMID: 36687560 PMCID: PMC9850867 DOI: 10.5500/wjt.v13.i1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/04/2022] [Accepted: 12/14/2022] [Indexed: 01/12/2023] Open
Abstract
The coronavirus disease 2019 pandemic has significantly impacted liver transplantation worldwide, leading to major effects on the transplant process, including the pretransplant, perioperative, and post-transplant periods. It is believed that patients with chronic liver disease, especially those with cirrhosis, have a higher risk of complications from coronavirus disease 2019 infection compared to the general population. However, evaluation of coronavirus disease 2019 effects on liver transplant patients has not uniformly demonstrated worse outcomes. Nonetheless, the pandemic created significant challenges and restrictions on transplant policies and organ allocation.
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Affiliation(s)
- Shrouq Khazaaleh
- Department of Internal Medicine, Cleveland Clinic Fairview Hospital, Cleveland, OH 44126, United States
| | - Mohammad Alomari
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL 33331, United States
| | - Sanskriti Sharma
- Department of Internal Medicine, WellStar Atlanta Medical Center, Atlanta, GA 30312, United States
| | - Nikhil Kapila
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL 33331, United States
| | - Xaralambos Bobby Zervos
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL 33331, United States
| | - Adalberto Jose Gonzalez
- Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, FL 33331, United States
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Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has significantly impacted all aspects of healthcare including solid organ transplantation. In this review, we discuss the specific impact of COVID-19 on the pediatric solid organ transplant population including access to grafts for pediatric transplant candidates as well as COVID-19 disease manifestations in pediatric transplant recipients. We address the current knowledge of prevention and management of COVID-19 in pediatric transplant recipients and provide additional information regarding social distancing, infection prevention and return to school.
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Affiliation(s)
- Amy G Feldman
- Pediatric Liver Transplant Center, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Digestive Health Institute, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Lara A Danziger-Isakov
- Immunocompromised Host Infectious Disease, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7017, Cincinnati, OH 45229, United States.
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4
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Hurst DJ, Potter J, Padilla LA. Organ transplant and Covid-19 vaccination: Considering the ethics of denying transplant to unvaccinated patients. Clin Transplant 2022; 36:e14589. [PMID: 35030283 DOI: 10.1111/ctr.14589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 12/01/2022]
Abstract
Recently, a number of organ transplant centers in the United States have proposed to only allow patients who have received the Covid-19 vaccination to be active on their transplant waiting list. This raises numerous ethical issues. This analysis utilizes current empirical data and the guidelines on the ethics of organ allocation published by the Organ Procurement and Transplant Network to guide our ethical reasoning. We conclude that it would be permissible to mandate Covid-19 vaccination as a condition of being listed for an organ transplant at a transplant center and offer recommendations for how to do so.
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Affiliation(s)
- Daniel J Hurst
- Department of Family Medicine, Rowan, University School of Osteopathic Medicine, Stratford, New Jersey, USA
| | - Jordan Potter
- Department of Clinical Ethics, WellStar Health System, Atlanta, Georgia, USA
| | - Luz A Padilla
- Department of Surgery, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Huang HJ, Yi SG, Mobley CM, Saharia A, Bhimaraj A, Moore LW, Kloc M, Adrogue HE, Graviss EA, Nguyen DT, Eagar TN, Jones SL, Ankoma-Sey V, MacGillivray TE, Knight RJ, Gaber AO, Ghobrial RM. Early humoral immune response to two doses of severe acute respiratory syndrome coronavirus 2 vaccine in a diverse group of solid organ transplant candidates and recipients. Clin Transplant 2022; 36:e14600. [PMID: 35083796 DOI: 10.1111/ctr.14600] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
Abstract
Response to two doses of a nucleoside-modified messenger ribonucleic acid (mRNA) vaccine was evaluated in a large solid-organ transplant program. mRNA COVID-19 vaccine was administered to transplant candidates and recipients who met study inclusion criteria. Qualitative anti-SARS-CoV-2 Spike Total Immunoglobulin (Ig) and IgG-specific assays, and a semi-quantitative test for anti-SARS-CoV-2 Spike protein IgG were measured in 241 (17.2%) transplant candidates and 1,163 (82.8%) transplant recipients; 55.2% of whom were non-Hispanic White and 44.8% identified as another race. Transplant recipients were a median (IQR) of 3.2 (1.1, 6.8) years from transplantation. Response differed by transplant status: 96.0% vs 43.2% by the anti-SARS-CoV-2 Total Ig (candidates vs recipients, respectively), 93.5% vs 11.6% by the anti-SARS-CoV-2 IgG assay, and 91.9% vs 30.1% by anti-spike titers after two doses of vaccine. Multivariable analysis revealed candidates had higher likelihood of response vs recipients (odds ratio [OR], 14.6; 95 %CI 2.19, 98.11; p = 0.02). A slightly lower response was demonstrated in older patients (OR 0.96; 95 %CI 0.94, 0.99; p = 0.002), patients taking antimetabolites (OR, 0.21; 95% CI 0.08, 0.51; p = 0.001). Vaccination prior to transplantation should be encouraged. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Howard J Huang
- Department of Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Stephanie G Yi
- Department of Surgery, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Constance M Mobley
- Department of Surgery, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Ashish Saharia
- Department of Surgery, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Arvind Bhimaraj
- Department of Cardiology, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Linda W Moore
- Department of Surgery, Houston Methodist Hospital, Houston, TX, 77030, USA.,Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Malgorzata Kloc
- Transplant Immunobiology, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Horacio E Adrogue
- Department of Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Edward A Graviss
- Department of Surgery, Houston Methodist Hospital, Houston, TX, 77030, USA.,Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Todd N Eagar
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - Stephen L Jones
- Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, 77030, USA
| | | | | | - Richard J Knight
- Department of Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - A Osama Gaber
- Department of Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
| | - R Mark Ghobrial
- Department of Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA
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Parent B, Caplan A, Mehta SA. Ethical considerations regarding COVID-19 vaccination for transplant candidates and recipients. Clin Transplant 2021; 35:e14421. [PMID: 34241923 PMCID: PMC8420300 DOI: 10.1111/ctr.14421] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/17/2021] [Accepted: 07/04/2021] [Indexed: 12/24/2022]
Abstract
Solid organ transplant (SOT) candidates and recipients were not included in the COVID‐19 vaccine trials that have justified vaccine administration to millions worldwide and will be critical to ending the pandemic. The risks of COVID‐19 for SOT candidates and recipients combined with data about this population's response to other vaccines has led to transplant centers recommending vaccination for their candidates and recipients in accordance with guidance from major transplant organizations. Relevant ethics considerations include: weighing the low risk of vaccination causing transplant complications against potentially limited antibody response of vaccines for transplant recipients; the equitable distribution of vaccines among vulnerable populations; the duty to steward and respect organs as limited resources; the duty to support vaccination; and patient autonomy. Vaccinated transplant patients and candidates should also consider participating in research studies to better understand the efficacy and potential long‐term risks in this patient population. There are difficult scenarios, like timing transplant after second vaccine dose, when to administer the second dose to a partially vaccinated candidate who gets an organ match, whether to vaccinate a recent transplant recipient with low exposure risk and which vaccine to use. Here we provide ethics considerations for vaccinating different groups within the transplant population.
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Affiliation(s)
- Brendan Parent
- Department of Population Health, Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Arthur Caplan
- Department of Population Health, Division of Medical Ethics, NYU Grossman School of Medicine, New York, New York, USA
| | - Sapna A Mehta
- NYU Transplant Institute, NYU Langone Health, New York, New York, USA
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