RECOVAC has yielded some important insights in the almost two years that it has been running. Dialysis patients, for example, appear to be well protected against corona after a vaccination. Initially, transplant patients made much less or even no antibodies after a vaccination. But that turned out to be different after the third shot. After the fourth, almost all transplant patients even make antibodies against corona.
Are transplant patients still more vulnerable when it comes to corona?
‘Patients after transplantation remain a vulnerable group. We do see that indeed more and more patients are producing antibodies and that disease and mortality are certainly decreasing, but that applies to the current variants of the virus. You cannot fully translate the results into any future variants. In addition, people with antibodies can still get infected. And we also see that patients can keep complaints for a long time.
At the moment the problem is not that big, but it was the same during this period last year. Then, at the end of September, a peak started again. I think that as hospitals we should be prepared for an increase in admissions.’
What can kidney patients expect from new drugs in the near future?
‘It is important to realize that we already have an arsenal of good medicines and treatment options. Think of administering oxygen and anticoagulation, but also drugs such as dexamethasone. With the current treatment we have been able to reduce the mortality from covid enormously.
Evusheld is available as a new drug, but the effectiveness of the most recent omikron variants (4 and 5) has not been proven. The guidelines in the Netherlands now say to exercise restraint and possibly give this drug to a small group of patients with a high risk.’
What about Paxlovid? Will that be available in the Netherlands?
‘Paxlovid inhibits the multiplication of the virus, and is not yet on the market in the Netherlands. It can only be given to people with good kidney function with an eGFR above 30. In addition, the drug has a strong interaction with other drugs that transplant patients are taking. We only consider this drug if there is a high risk of a serious course, just like with Evusheld.’
Are there any vaccines in the works that hold promise for transplant patients?
‘Yes, Pfizer and Moderna have adapted their vaccines to target the omikron variant specifically. They have just been approved in Europe. That is hopeful, because the previous vaccines protected well against serious illness, but less well against minor infections. People with minor infections can also infect transplant patients. These modified vaccines show a high immune response to the omikron variant.’
What are the latest developments from the RECOVAC consortium?
‘We have sent out questionnaires to find out how long transplant patients continue to suffer from corona complaints. We don’t know much about that yet. We are also working on an overview of the psychosocial impact of COVID-19 and vaccination on our patients.
At the end of July we published an article about a study looking at the response of antibodies and T cells after vaccination. We saw a clear decrease after six months. This makes it plausible that it is extremely important to take a booster.
We also conducted a study on the best strategy for repeated vaccination in transplant patients. We investigated whether a double dose of Moderna, the Janssen vaccine or stopping the drug Cellcept for two weeks caused an even better response to vaccination. These results will be published shortly.’
What advice do you as a doctor give to patients?
‘We do not recommend fully insulating (shielding). We still say: try not to shake hands, keep 1,5 meters away if possible and call the hospital in case of complaints. The most important advice is: get vaccinated.’