Transplant recipients face uncertainty as virus cases rise

COVID-19 vaccines offered the promise of a return to normalcy for many — but many organ transplant recipients continue to live with the unknown, unsure of how much protection the vaccine offers them.

Kim Burdakin was fully vaccinated by the end of March, and the shot gave her the opportunity to dine in restaurants and work out in a gym for the first time in over a year.

Burdakin, 60, who splits her time between Muscatine and Chicago, received a liver transplant in 2000 and ever since has taken drugs that prevent her body from rejecting the organ. These drugs also suppress the immune system.

She’s taking part in a study at Johns Hopkins University examining the results of the COVID-19 vaccine on transplant patients.

Burdakin said she is one of the lucky transplant patients who produced antibodies after receiving the COVID-19 vaccine. But there is uncertainty as to just what these numbers mean.

“What we don’t know is how many antibodies do you need? What is the safe number, and do we even know what that number is?” Burdakin asked.

Dr. Dilek Ince, an infectious disease specialist at the University of Iowa Hospitals and Clinics, said that the COVID-19 vaccine is routinely recommended for most transplant recipients. The vaccine is safe for these patients to receive, she said, but she recommends transplant patients also continue to take precautions like masking and social distancing.

"We do expect that they might not develop as robust an immune response to the vaccine, and they might not be protected from severe disease and hospitalization as much as an immunocompetent person,“ Ince said.

The study Burdakin participated in at Johns Hopkins University found that 17 percent of transplant patients produced antibodies after receiving their first dose of the vaccine, and 54 percent had antibodies after receiving the second dose.

Ince said these antibody tests are not routinely recommended for patients outside of research settings.

“We don’t know of an exact threshold above which a person is going to be protected,” she said. “There are multiple different kinds of tests out there, and not all of them evaluate what we call the naturalizing antibody. So it can actually be very confusing for patients.”

Burdakin said she and her husband are huge Hawkeye football fans and are trying to decide if they feel comfortable attending full capacity games in the fall.

She continues to take precautions, wearing her mask out in public, and asking those around her to do the same.

“My family, my friends, I have to rely on them to keep me safe, which for me is really hard,” she said. “It’s hard to ask people to mask up if they’re already vaccinated, because we just don't know how safe we really are, even though we have the vaccine.”

Burdakin said the biggest challenge for her is balancing safety precautions with living a fulfilling life.

“I have this gift, I have been given this wonderful organ that saved my life, but hunkering down and not living my life doesn’t seem fulfilling,” she said. “It’s hard to balance safety and living our life.

Booster doses

Hailey Steimel says she doesn’t go out much — making the occasional trip to the store or to a friend’s place.

The 24-year-old heart transplant recipient from Cedar Rapids has been vaccinated, but she’s worried about the increase in COVID-19 cases and the more contagious delta variant of the virus.

“It is really hard because I do want to get out and do more things,” she said.

She didn’t get any form of antibody testing — her doctors didn’t recommend it. Steimel said she hopes a third dose of the vaccine will be a possibility soon for transplant recipients and other vulnerable groups.

“I’m hoping we’re approved for a third shot soon. … I’m hoping wearing my mask and having the COVID shot, I have some antibodies to protect myself,” she said.

The Food and Drug Administration moved to approve booster doses of the vaccine for immunocompromised people last Thursday.

Dr. Camille Kotton is clinical director of transplant and immunocompromised host infectious diseases and a member of the CDC’s advisory committee on immunization practices. She said there are studies showing that a third dose of the vaccine boost immune system response.

Kotton said the more contagious delta variant is escalating the risk of infection.

“I’m actually quite worried for immunocompromised patients that this will really be making things worse right now,” she said.

Burdakin said she is hopeful about the possibility of receiving a third dose.

“I have to say I’ll continue to social distance and wear a mask even with a third a vaccine, but I feel like it does offer a little more protection if it does mean I’ll have additional antibodies,” she said.

Steimel said though she is worried about the increase in cases, she hopes it is a sign for more people to consider getting a vaccine.

“I feel like if I never had a transplant and I was perfectly healthy, I would still have a shot to protect other people,” she said.

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