For transplant recipients, virus fears remain

Madeline Buckley
Chicago Tribune

CHICAGO — Even though she is fully vaccinated, Barbara Creed can’t yet visit her grandchildren in Texas.

Creed is among thousands for whom the vaccine is less effective because she has received an organ transplant. The 67-year-old Oak Park, Illinois, resident has watched the state reopen with some trepidation, as mask mandates for the unvaccinated are on an honor system and the delta variant of the virus circulates in Illinois.

People such as Creed with compromised immune systems rely on others to be vaccinated for full protection against the virus. But the country’s march toward herd immunity has been stymied by people who have declined to get vaccinated. The country just missed President Joe Biden’s goal of giving at least one shot to 70% of Americans by the Fourth of July, as vaccine hesitancy still flourishes in some communities.

Precautions: That means Creed may live for the foreseeable future with restrictions that others who are vaccinated can largely be free of.

She still takes many precautions: wearing masks in public, social distancing and only socializing with small groups of people who are all vaccinated. She is abstaining from travel, as much as she wants to visit her grandchildren. Instead, they will likely travel to Illinois to visit with her.

“Not only is flying a bad idea for a person who is compromised, but you just can’t transpose yourself to another community and know what it is like down there,” she said.

Transplant patients take drugs to suppress their immune system so that their body doesn’t reject the donated organ. Creed, a retired music teacher, received a double lung transplant last year.

The vaccine — while extremely effective for most people — likely offers some protection to transplant patients, but still leaves them more vulnerable to contracting the disease and becoming hospitalized, said Dr. Daniel Dilling, professor of medicine at the Loyola University Stritch School of Medicine and the medical director of the hospital’s lung transplant program.

‘An act of patriotism’: Transplant patients want people to know that it is essential for healthy people to get the vaccine to protect those who have compromised immune systems.

“It’s an act of patriotism to get the vaccine for the sake of our fellow citizens, to collectively do what we can as a community to fight this virus together,” Dilling said. “It’s the American way.”

Organ transplant patients weren’t studied in the original vaccine trials, but Flossmoor, Illinois, resident Monica Fox is participating in a study by Johns Hopkins on the vaccine’s effectiveness in transplant patients.

Fox, who received a kidney transplant in 2016 after living on dialysis for three years, got the vaccine and has periodically been tested for COVID-19 antibodies. So far, the tests have not found them.

“I was disappointed but I was glad to know so I didn’t have a false sense of total security,” Fox said.

Antibody tests offer some data but are an imperfect measure of a person’s level of protection against the virus. Dilling said cells that can fight infections, called T cells, could offer protection against the virus, even if people do not develop antibodies. An individual’s T cell response is not something measured in most labs, he said.

But some organ transplant patients are becoming reinfected, sometimes becoming ill enough to be hospitalized, Dilling said. That, coupled with the fact that some patients participating in studies, like Fox, do not appear to have developed antibodies, indicates a weakened level of protection.

“Those two things together tell us that the vaccine just isn’t quite as protective in people who have a compromised immune system,” he said.

And even in cases when a transplant patient has developed some antibodies, the advice is to continue masking and take other precautions, Dilling said.

“If they do have an antibody response, it’s not as big as the general public,” he said.

Anxiety: At the beginning of the pandemic, Fox told friends who were suddenly having to be more careful in public, “welcome to my world” because transplant recipients are used to masking and taking precautions in crowds. But the emergence of the virus was frightening, and it could have a devastating impact on her if she contracted it.

Mark Lakoduk, a lung transplant recipient who lives in Norridge, stopped making food deliveries when the pandemic hit, following the advice of his doctors. And he stopped kissing his wife.

“We were so worried about it,” he said. “Before COVID we would kiss each other good night every night.”

Lakoduk has resumed food deliveries and other activities, especially because he contracted COVID-19 in January and recovered from it. And he has continued kissing his wife good night.

But the return to normalcy is anxiety-inducing for some transplant recipients. It’s hard to know who might be a threat to their safety.

“People who don’t want to get vaccinated also don’t want to wear masks,” Fox said.

Booster: In a study published earlier this month, Johns Hopkins researchers found that a third vaccine shot may increase antibody levels in transplant patients, according to a news release.

That news offered some hope to Creed, who said she would take a third shot if it became available, though Dilling noted doctors can’t order a third vaccine for patients as it has not been approved under the FDA’s emergency use authorization.

But the outlook in the state has markedly improved since the vaccines were first approved late last year, with a seven-day rolling average of case and test positivity rates of under 1%, according to the Illinois Department of Public Health. More than 69% of people 12 and older in Illinois have received at least one dose of the vaccine, according to state data.

Dilling said most of Loyola’s hospitalized COVID-19 patients are younger people who chose not to be vaccinated.

Fox went to get her nails done recently, the first time since the state allowed salons to reopen. She wore her mask, even though the salon did not require it anymore. She is also able to spend time with her family members who are vaccinated.

But she worries about vaccine skepticism in the long run. Fox works as director of outreach and government relations at the National Kidney Foundation of Illinois and is working on programming to increase vaccine uptake.

“People need good information,” she said. “I know we are tired of lockdowns. I know we are tired of wearing masks, but consider that there is a substantial population of people who are still at risk.”