16 March 2020

Page last updated on Wednesday 5 January 2022 at 13:53. 

Outpatient appointments

There are restrictions on the number of outpatients that we can bring into Royal Papworth Hospital in order to keep all patients within the hospital safe.  

We will contact you before your next appointment and let you know whether we will see you in person or whether we will convert your appointment to a virtual appointment. Please do not just turn up to the hospital. 

If we are unable to see you in person, then we may ask you to have blood tests performed locally. If you are uncertain whether you should attend your appointment, please contact the transplant unit on 01223 638007. 

If you still have a question after reading the FAQs below, please email the transplant continuining care team.
 

Latest FAQs

What can I do to keep myself safe? 
Am I at an increased risk from COVID-19? 
What should I do if I feel unwell?
Should I be vaccinated against COVID-19?
What about third primary doses and booster doses of the COVID-19 vaccine?
What happens after my COVID-19 vaccine?
Have COVID-19 vaccines been helpful for UK transplant patients?
What should I do if I test positive for COVID-19?
What COVID-19 treatments are available for transplant patients?
What about the Omicron variant?
Should I attend my outpatient appointment?

Are you still performing transplants?
Will I still be able to access my medicines / do I need to stockpile?
How you can help...


What can I do to keep myself safe? 

Follow national guidance in order to keep safe and reduce spread of the virus. The guidance changes frequently and it is important to keep updated.

Get your COVID-19 vaccines and your booster dose when available (further information on COVID-19 vaccines for transplant patients in questions below).
• Wear a face covering in most indoor public places and on public transport.
• Work from home, if you can.
• Let fresh air in if you meet indoors; meeting outdoors is safer.
Get tested for coronavirus and self-isolate if required.

There is also specific guidance for people who are clinically extremely vulnerable. You may want to download the government COVID-19 app, which provides local information about infection rates and can help with tracking/tracing of contacts.


Am I at an increased risk from COVID-19? 

Transplant patients are ‘clinically extremely vulnerable’. According to data collected by NHS Blood and Transplant, 9.0% of heart transplant recipients and 10.8% of lung transplant recipients had tested positive for COVID-19 by 8th October 2021. Sadly, 10.1% of heart transplant patients and 23.2% of lung transplant patients died within 28 days of a positive COVID-19 test.

Transplant patients may be at particularly high risk if they have established graft damage that has occurred since transplant or have another risk factor such as: older age; being from a Black, Asian or minority ethnic group; obesity; or kidney problems. Lung transplant patients who require oxygen or NIV are likely to be at the highest risk.

Patients with chronic heart or lung disease are also at increased risk of developing severe COVID-19, so we believe that patients who are waiting for heart or lung transplantation should also be classed as ‘clinically extremely vulnerable’.


What should I do if I feel unwell?

Symptoms of COVID-19 may be similar to other problems in transplant patients which can make it difficult to decide the best course of action. Regular spirometry is recommended for lung transplant patients.

If you develop fever, cough or difficulty breathing you should call the transplant unit on 01223 638007. If you are generally well despite having coronavirus symptoms, it is likely we will ask you to arrange local COVID-19 testing.

If you are unwell or you are a lung transplant patient with a drop in lung function, then you may be advised to go to hospital. If you are advised to come to Royal Papworth Hospital, please stay in your car and call the transplant unit nurses on 07775 587395 when you arrive. A member of staff will direct you to the most appropriate place. Do not enter our hospital without making contact with the transplant team.


Should I be vaccinated against COVID-19?

We strongly recommend that you and eligible members of your household are vaccinated. More than 134 million doses of the AstraZeneca, Pfizer and Moderna COVID-19 vaccines have been administered in the UK and 82.8% of those aged 12 or over are fully vaccinated.

Many COVID-19 vaccines use new technology. The Pfizer and Moderna vaccines use a piece of genetic material (mRNA) for spike protein, a surface protein on the COVID-19 virus. The AstraZeneca vaccine also uses genetic material for spike protein but this gets into the body using an inactivated chimpanzee adenovirus. Vaccines offer protection if you subsequently encounter the COVID-19 virus, either by preventing or reducing the severity of illness. There are very rare side effects from COVID-19 vaccines but we believe they are safe for transplant patients.

COVID-19 vaccine information.


What about third primary doses and booster doses of the COVID-19 vaccine?

Adults who were immunosuppressed at the time of their first or second vaccine doses, such as transplant patients, should get a third primary vaccine dose. This is called a third primary dose, rather than a booster, because it completes your primary course of vaccination. However, the actual vaccine used is identical to a booster.

We recommend that all our transplant patients receive a third primary vaccine dose, at least eight weeks after their second dose. The Pfizer or Moderna vaccine is preferred but the AstraZeneca vaccine may be used if you have received this previously. We do not suggest any changes to your immunosuppression at the time of vaccination.

Third primary COVID-19 vaccine dose for people who are immunosuppressed - JCVI advice.

Once a transplant patient has received all three primary vaccine doses, then any subsequent doses are called a booster. It is likely that transplant patients will be among the first patients in the UK to receive a fourth vaccine dose in 2022.


What happens after my COVID-19 vaccine?

We recommend that you continue to follow national guidance and endeavour to keep yourself safe after vaccination.

It is important to acknowledge that COVID-19 vaccines are less effective in transplant patients. Studies have shown that around one-third of transplant patients have no detectable antibody response to COVID-19, even after a third dose of vaccine. However, it is possible that the cellular response to vaccination (which cannot be easily measured) is more important than the antibody response.

We can measure your COVID-19 antibody levels at your next outpatient appointment if you wish. This helps us understand your response to vaccination and may help us advise you about treatments if you catch COVID-19. It is important to understand that an antibody test does not tell you whether you are ‘safe’ from COVID-19.

If you are interested in knowing more about COVID-19 antibody levels, then please consider joining the MELODY study, which aims to recruit people who have received solid organ transplants. 


Have COVID-19 vaccines been helpful for UK transplant patients?

This is a very difficult question to answer. Vaccines became available in December 2020. When enough of the UK population have been vaccinated, then the pandemic should ease. This is likely to be the most important way in which the vaccine helps transplant patients.

NHS Blood and Transplant and the UK Health Security Agency have been monitoring COVID-19 in all 40,000 transplant patients in the UK as they have been vaccinated.

Unfortunately, two doses of vaccine does not reduce the risk of testing positive for COVID-19 however it does reduce the risk of dying from COVID-19 by around 20%. It appears that the AstraZeneca vaccine may be more effective than the Pfizer vaccine at reducing the risk of death. We believe that a third primary vaccine dose and subsequent booster dose may increase protection for transplant patients. 

Latest NHS advice on COVID-19 vaccine for patients and recipients - NHS Organ Donation.


What should I do if I test positive for COVID-19?

You must self-isolate if you test positive.

Please contact the transplant unit on 01223 638007 to let us know. Do not stop taking your immunosuppression. We will tell you if your medications need to change. You may be contacted by NHS Test and Trace. 

Help is available while you are self-isolating, including financial support and practical help with everyday tasks like collecting shopping or medicines.

Contact us if symptoms worsen while you are self-isolating. Depending on your circumstances, we may ask you to call NHS 111 or use NHS 111 online.

If you develop life-threatening symptoms such as difficulty in breathing, blue lips, pale/blotchy skin, collapse or drowsiness/confusion, immediately dial 999 and tell the operator that you have COVID-19.


What COVID-19 treatments are available for transplant patients?

New treatments are becoming available for COVID-19 all the time and the NHS is trying to deliver these treatments outside hospital where possible. This is a rapidly evolving area and the best treatment option is likely to vary from patient to patient.

Sotrovimab is a neutralising monoclonal antibody and is given as an intravenous infusion. It sticks to the COVID-19 virus and stops it from getting into your lungs. Molnupiravir is a tablet that interferes with viral replication. Both medications reduce the risk of severe COVID-19. They are recommended as soon as possible after a positive COVID-19 PCR test and within five days of symptom onset.

Transplant patients are eligible for treatment with Sotrovimab and Molnupiravir. We have written to you about keeping a PCR test at home, so you can do a rapid test if you develop symptoms. If you test positive, then you will be called by an expert clinician from your local NHS COVID Medicines Delivery Unit (CMDU) who will discuss the most appropriate treatment. Sotrovimab will be given at the CMDU, while Molnupiravir can be collected or delivered to your home.

More information about Sotrovimab - patient information leaflet.

More information about Molnupiravir - patient information leaflet.

A treatment called Paxlovid (Nirmatrelvir and Ritonavir) may be available soon but is generally not appropriate for transplant patients because it interacts with immunosuppression. 

Other treatments are available in hospital. Ronapreve is a combination of two monoclonal antibodies (Casirivimab and Imdevimab). It reduces mortality for patients who are hospitalised with COVID-19 but do not have antibodies of their own. Unfortunately, Ronapreve does not have activity against the Omicron variant. For the most unwell patients, Dexamethasone, Remdesivir, Tocilizumab and Sarilumab may be considered by the doctors looking after you. These medications are safe for transplant patients.


What about the Omicron variant?

New variants of coronavirus emerge all the time, particularly in unvaccinated populations. The Omicron variant emerged in November 2021 and has rapidly spread to become the dominant variant in most countries of the world. Omicron is more transmissible than the previous dominant variant (Delta) but may cause milder illness.

We think vaccines offer less protection against Omicron than previous variants, particularly if an individual’s last vaccine dose was more than three months ago. An enhanced booster programme has been in place in the UK since December 2021 and current vaccines may be modified to provide better immunity against Omicron.

 

Should I attend my outpatient appointment?

There are restrictions on the number of outpatients that we can bring into Royal Papworth Hospital in order to keep all patients and staff safe within our hospital.

We will contact you before your next appointment and let you know whether we will see you in person or whether we will convert your appointment to a 'virtual' appointment. If we are unable to see you in person then we may ask you to have blood tests performed locally.

If you are uncertain whether you should attend your appointment, please contact the transplant unit on 01223 638007 before you travel to Royal Papworth Hospital.
 

Are you still performing transplants?

Our programme has remained open for heart and lung transplantation throughout the pandemic. Although we prioritised our most unwell patients during the peaks of the pandemic, our program has now returned to standard pre-pandemic practice. We are confident that we can safely perform transplants and protect immunosuppressed patients in our hospital.

There are COVID-19 patients in our hospital at the moment and the number will inevitably increase during future waves. It is still possible that we may be unable to do a transplant because of ‘logistical’ problems on the day or night, such as lack of an intensive care unit bed after the operation.

We keep the situation under regular review. Like all transplant units, we would only stop transplantation as a last resort. This might happen if our hospital became too full to be safe or if there were severe staff shortages.
 

Will I still be able to access my medicines / do I need to stockpile?

We continue to work closely with our NHS partners (e.g. Homecare) to make sure we have enough supplies of medicines for our patients. If you are currently receiving medicines such as anti-rejection medication from Homecare, this will continue. The main change people may experience is that drivers may not ask for a signature and may stay a safe distance away from patients by setting the parcel down and then walking away and waiting for the recipient to pick up the parcel. No medicines will be left unattended.

Please see our pharmacy COVID-19 page for more information. 


How you can help...

As usual, make sure you have enough ‘buffer stock’ by keeping at least two to four weeks’ worth of your medicines at all times, and requesting repeat prescriptions or Homecare deliveries well in advance of this supply running out. That will give your pharmacy or Homecare provider enough time to deal with any shortages should they arise. This is standard practice for our patients and not new advice.

If you are experiencing any difficulty getting hold of a supply of your medicines, or if you have any concerns about their availability, please let the transplant continuing care team know as soon as possible by emailing papworth.transplant.continuingcare@nhs.net.