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Who gets an organ transplant? Waitlist rules are complicated.

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Last week, a hospital in Boston removed a patient from its heart transplant waiting list over his refusal to receive a COVID vaccine. Although many hospitals had been enforcing such policies throughout the pandemic, the news took off internationally.

But the spotlight on vaccination status ignores the complexities of organ transplantation outside the pandemic. “There are a ton of requirements for transplant eligibility,” says Dorry Segev, a transplant surgeon at New York University. The ethics of transplant decision-making are different from those of other kinds of medical care, in large part because there are fewer organs than there are people in need. According to the American Transplant Foundation, more than 100,000 Americans are currently on transplant waitlists.
Read more here.

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What are the Common Lab Tests That Patients Receive After Heart Transplant?

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As a heart transplant recipient, you’ll quickly find yourself being asked to take a laundry list of blood tests. While this can be inconvenient and frustrating, it’s also really important. Your doctor can’t tell what’s going on with your new heart by looking at you. Blood tests provide information on how well your heart is functioning and how your medications may be affecting your body. By reviewing the results, your physician may adjust medications, recommend changes to your diet or fluid intake, or recognize the need for additional examination.

But what are the specific tests and what is the purpose of each? With the help of Dr. Shelley Hall, Chief of Transplant Cardiology and Mechanical Support/Heart Failure at a large university medical center in the southern US, in this article we discuss:

– Complete blood count
– Comprehensive metabolic panel
– Infection testing
– Natriuretic peptide test
– Immunosuppressive drug levels
– Donor specific antibodies
– AlloMap® Heart
– AlloSure® Heart

Read more here.

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Most liver transplant recipients mount adequate COVID-19 antibody response

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The majority of liver transplant recipients are able to produce a functional antibody response to COVID-19 infection, according to data published in Gut.

“Our findings suggest that the humoral response of [liver transplant (LT)] recipients is only slightly lower than expected compared with that of COVID-19 immunocompetent controls,” Chiara Becchetti, MD, of the department of visceral surgery and medicine at the University of Bern in Switzerland, and colleagues wrote. “Additionally, we showed that the majority of LT recipients is capable of mounting an adequate neutralizing activity against SARS-CoV-2 and that neutralizing ability was associated with the presence of antinucleocapsid antibodies.” Learn more here.

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Lung transplants encouraging treatment for COVID-19 patients, but long-term outcomes still uncertain

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Recent data bolster the value of lung transplants for some COVID-19 patients, indicating they do as well after surgery as those who needed new lungs for other reasons.

The complicated, risky procedure remains rare, though, doctors said, and there is still much they’re learning about how well transplants work for COVID-19 patients. Learn more here.

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Some Kidney Transplant Patients Respond to Fourth COVID Vax Dose

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“A fourth dose of mRNA COVID-19 vaccine boosted antibodies among half of kidney transplant recipients with suboptimal immune responses after three doses, a French case series found.

Among 92 patients with low anti-spike IgG titers (below 143 binding antibody units/mL) 1 month after the third dose, 50% reached the 143 BAU/mL threshold considered adequate against the initial COVID variants at 1 month following their fourth dose, reported Sophie Caillard, MD, PhD, of Hôpitaux Universitaires de Strasbourg in France, and colleagues.”

Read more here.

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First successful pig-to-human heart transplant may offer new options for patients

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  • A team of surgeons from the University of Maryland School of Medicine recently transplanted a genetically-modified pig heart into a 57-year-old male from Baltimore, MD.
  • The patient, who had arrhythmia, was not a viable candidate for the heart transplant list or an artificial heart pump.
  • The pig heart had 10 genetic modifications, including the removal of four pig genes and the addition of six human genes.
  • The surgical team hopes the continued success of this transplant will provide a new way to help those on the organ donor list.
  • However, some in the medical community question the ethical considerations of this type of transplant

Read more, here.

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FAQ: COVID-19 Basics for Transplant Patients

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“If you or a loved one is a UCSF transplant patient, you can find answers here to questions about the COVID-19 vaccines and how to otherwise minimize your risk of infection.

Should I get a fourth dose of the vaccine?

Yes. For immunosuppressed individuals, a series of three mRNA doses is now considered a “primary” series of vaccination against COVID-19. The CDC has approved a fourth dose, as a booster, that you can, and should, get six months after the third shot.

Does vaccination protect against the latest variant of the virus?

Existing vaccines likely do provide some immunity against omicron, the newest known variant of COVID-19, but boosters are important to maximize protection, according to a CDC statement issued when omicron was first detected in South Africa on Nov. 26, 2021. Omicron is now circulating in the United States and is variant has been labeled a “variant of concern” by the World Health Organization. It’s considered more contagious than earlier variants, though it’s not yet clear to what extent it poses risk of severe disease.”

Read more here.

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20 Common Kidney Transplant Q&A

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“When your kidneys fail, treatment is needed to replace the work your own kidneys can no longer do.  There are two types of treatment for kidney failure: dialysis or transplant. Many people feel that a kidney transplant offers more freedom and a better quality of life than dialysis.  In making a decision about whether this is the best treatment for you, you may find it helpful to talk to people who already have a kidney transplant. You also need to speak to your doctor, nurse and family members.”

Learn more here.

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COVID-19 Vaccines for Moderately or Severely Immunocompromised People

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“DEFINITION: Immunocompromised

Having a weakened immune system can make you more likely to get severely ill from COVID-19. Many conditions and treatments can cause a person to be immunocompromised or have a weakened immune system. Primary immunodeficiency is caused by genetic defects that can be inherited. Prolonged use of corticosteroids or other immune weakening medicines can lead to secondary or acquired immunodeficiency.”

Learn more here.

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