Solid organ transplantation and SARS-CoV-2 vaccines: is there a possible alternative?

The spread of the SARS-Cov-2 virus has been a major public health problem for 2 years, especially for those immuno-suppressed patients such as those solid organ transplant recipients (SOTRs). DNA and RNA-based vaccines represent an excellent weapon to reduce the spread of the virus, but there are currently no consolidated scientific data to support the safety and efficacy of nucleic acid-based vaccines in organ transplant patients, having not been included in the phase I-III clinical trials that considered immunosuppressive or immunodeficient state among main exclusion criteria during study subjects enrollment. Solid organ transplant recipients have a reduced humoral immune response to DNA and RNA vaccines compared to the immunocompetent counterpart, thus remaining at high risk for COVID-19. Vaccines are consid-ered safe for all SOTRs, but there are in literature some reports of problems due to the vaccination in these patients such as episode of steroid-resistant acute cellular rejection and two cases of endothelial corneal allograft rejection following immunization. It is therefore essential that the immune-incompetent population continues to practice strict precautions for covid-19 even post vaccination and to keep in mind other therapeutic and preventive tools as an additional weapon against the virus.