Page last updated on Friday 10 November 2023 at 08:42
Outpatient appointments
We are now fully back to seeing our patients face-to-face in the outpatients department.
However, if you would prefer a virtual appointment, please contact the transplant unit on 01223 638007 so that we can arrange local blood tests before your appointment.
If you still have a question after reading the FAQs below, please email our transplant continuining care team.
Latest FAQs
Am I at an increased risk from COVID-19?
What about the new variants?
Should I be vaccinated against COVID-19?
Will I respond to COVID-19 vaccination?
Does vaccination reduce the risk of COVID-19 in transplant patients?
Can other treatments reduce my risk of catching COVID-19?
What else can I do to reduce my risk from COVID-19?
What should I do if I feel unwell?
What should happen if I test positive for COVID-19?
What COVID-19 treatments are available for transplant patients?
Should I attend my outpatient appointment?
Are you still performing transplants?
How you can help.
Am I at an increased risk from COVID-19?
Transplant patients were classed as ‘clinically extremely vulnerable’ during the first two years of the pandemic. This terminology is no longer used, but transplant patients remain at higher risk of serious illness due to COVID-19.
NHS Blood and Transplant collected data about COVID-19 in transplant patients for two years. At the time of the final NHSBT report in March 2022, 22.7% of heart transplant recipients and 22.6% of lung transplant recipients had tested positive for COVID-19. Sadly, 7.5% of heart transplant patients and 15.5% of lung transplant patients died within 28 days of a positive COVID-19 test.
The INFORM study - published in October 2023 - showed that immunocompromised patients, such as transplant patients, remain at higher risk of admission to hospital, admission to ICU or death due to COVID-19.
Transplant patients may be at particularly high risk if they have graft damage that has occurred since transplant or have another risk factor such as older age, obesity, kidney problems, or are from a Black or Asian minority ethnic group.
Lung transplant patients who require oxygen or non-invasive ventilation (NIV) are likely to be at the highest risk. Patients with chronic heart or lung disease who are waiting for transplantation are also at increased risk of serious illness due to COVID-19.
What about the new variants?
New variants of Coronavirus emerge all the time, particularly in unvaccinated populations.
The Omicron variant emerged in November 2021 and rapidly spread to become the dominant variant. Omicron is more transmissible than the previous dominant variant (Delta) but causes milder illness. There are a number of sub-variants of Omicron.
Current variants of interest are XBB.1.5, XBB.1.16 and EG.5.
Should I be vaccinated against COVID-19?
Yes. We strongly recommend that you and eligible members of your household are vaccinated. More than 150 million doses of COVID-19 vaccines have been administered in the UK.
Some 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. Vaccines are updated to provide better protection against current variants.
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 but they are safe for transplant patients. We do not suggest any changes to your immunosuppression at the time of vaccination.
Adults who are immunosuppressed, such as transplant patients, should get three vaccine doses for their primary course of vaccination. Once a transplant patient has received all three primary vaccine doses, then subsequent doses of vaccine are called a booster. Transplant patients will be offered regular booster vaccine doses.
Will I respond to COVID-19 vaccination?
It is important to acknowledge that all vaccines, including the COVID-19 vaccine, are less effective in immunosuppressed patients. The MELODY study showed that one-quarter of transplant patients have no detectable antibody response to COVID-19 vaccination, 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. An antibody test does not tell you whether you are ‘safe’ from COVID-19.
Does vaccination reduce the risk of COVID-19 in transplant patients?
This is a very difficult question to answer.
NHS Blood and Transplant and the UK Health Security Agency have been monitoring COVID-19 in all 40,000 transplant patients in the UK. Unfortunately, vaccination does not reduce the risk of testing positive for COVID-19, however it does reduce the risk of dying of COVID-19 by around 20%.
More information can be found on NHS Blood and Transplant - COVID-19 vaccination Q&As.
Can other treatments reduce my risk of catching COVID-19?
New treatments are being developed to reduce your risk of catching COVID-19.
Sotrovimab is a neutralising monoclonal antibody. It is given as an intravenous infusion and lasts around six months. Sotrovimab binds the spike protein on the outside of the COVID-19 virus and prevents it from entering cells.
We are currently recruiting patients to a large multi-centre clinical trial called PROTECT-V to see if primary prophylaxis with Sotrovimab is effective.
Evusheld is a combination of two monoclonal antibodies (Tixagevimab and Cilgavimab) and was studied in clinical trials earlier in the pandemic. Unfortunately, Evusheld is not effective against current variants of Omicron and it was not recommended for use by NICE for this reason.
What else can I do to reduce my risk from COVID-19?
We recommend that you follow national guidance to keep safe and reduce spread of the virus.
COVID-19: guidance for people whose immune system means they are at higher risk.
Measures which help include:
- Ensure you are vaccinated.
- Avoid contact with people who have symptoms of COVID-19.
- If you have visitors, ventilate your home by opening windows to let in fresh air.
- Consider asking visitors to take a lateral flow test before visiting you.
- Consider asking visitors to wear a face covering.
- Work from home if this feels right for you – if you cannot work from home, speak to your employer about what arrangements they can make to reduce your risk.
- Consider wearing a face covering in public spaces.
- Reduce the time you spend in enclosed crowded spaces.
- Wash your hands regularly and avoid touching your face.
Regular spirometry is recommended for lung transplant patients.
Finally, we recommend that you keep a COVID-19 lateral flow test kit at home, so you can do a test if you develop symptoms. Transplant patients in England are still eligible to receive lateral flow tests. You can order your lateral flow tests online or by calling 119.
What should I do if I feel unwell?
If you develop fever, cough or difficulty breathing you should perform a home lateral flow test.
Symptoms of COVID-19 may be similar to other problems in transplant patients. Please call the transplant unit on 01223 638007 if you wish to discuss your symptoms. If you are unwell or 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.
Do not enter the hospital without making contact with the transplant team.
What should happen if I test positive for COVID-19?
If you test positive for COVID-19, then call your GP or NHS 111. It is important to tell them that you are a transplant patient and may be eligible for COVID-19 treatments. It is also important to tell them that you take immunosuppression because this may interact with COVID-19 treatments, such as Paxlovid.
Please contact the transplant unit on 01223 638007 to let us know that you have COVID-19. Do not stop taking your immunosuppression. Whilst there is no legal requirement to self-isolate, you should minimise contact with other people. This helps reduce the chance of passing COVID-19 on to others.
Please contact us if your symptoms worsen. 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, then immediately dial 999 and tell the operator that you have COVID-19.
What COVID-19 treatments are available for transplant patients?
New treatments for COVID-19 are becoming available all the time and the NHS is trying to deliver these treatments outside hospital where possible. This is a continously evolving area and the best treatment option is likely to vary from patient-to-patient.
Transplant patients may be eligible for treatment with Sotrovimab, Molnupiravir or Remdesivir to reduce the risk of severe COVID-19. These treatments are recommended as soon as possible after a positive COVID-19 test and within five days of symptom onset. Sotrovimab and Remdesivir are intravenous infusions and are given in a healthcare facility. Molnupiravir is a tablet and can be collected or delivered to your home. Contact your local integrated care board to find out how to access COVID-19 treatments in your local area.
More information about Sotrovimab and Molnupiravir.
A treatment called Paxlovid (Nirmatrelvir and Ritonavir) is not appropriate for most transplant patients because it interacts with immunosuppression. It is very important that you do not take Paxlovid if you also take Ciclosporin (Neoral) or Tacrolimus (Prograf, Modigraf, Adoport) or Sirolimus (Rapamune). If you have been prescribed Paxlovid, then please do not take Paxlovid and contact our transplant unit on 01223 638007 for advice.
For the most unwell patients who are admitted to hospital, other treatments such as Dexamethasone, Tocilizumab and Sarilumab may be considered by the doctors looking after you. These medications are safe for transplant patients.
Should I attend my outpatient appointment?
Our outpatient clinics are working normally. If you are uncertain whether you should attend your appointment or concerned that you might have COVID-19, please contact the transplant unit on 01223 638007 before you travel to Royal Papworth Hospital.
Are you still performing transplants?
Yes. Our programme remained open for heart and lung transplantation throughout the pandemic.
We are confident that we can safely perform transplants and protect immunosuppressed patients in our hospital. There are very few COVID-19 patients in our hospital at the moment but the number might increase if there are future outbreaks. 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.