Coronavirus (COVID-19) Q&A for heart and lung-transplant recipients

Last updated August 2025

What can I do to keep myself safe?
Am I at increased risk?
What should I do if I feel unwell?
Is there a treatment for COVID-19?
What about the COVID-19 vaccine?
What should I do if I think I have been in contact with someone with COVID-19?
Should I self-isolate or work from home?
What is known about the effectiveness of the COVID-19 vaccine
Should I have the vaccine even if I had COVID-19?

What can I do to keep myself safe?

Please follow national guidance on what you can do to keep yourself safe. According to the UK Health Security Agency (UKHSA) guidance, all cardiothoracic transplant patients are clinically extremely vulnerable.

The shielding programme ended in England on 15 September 2021, which means that people who were previously considered clinically extremely vulnerable are now not being advised to shield. There is specific guidance for people whose immune system means they are at higher risk of serious illness if they become infected with COVID-19, which can be found here.

It is recommended that all transplant patients are vaccinated for COVID-19 as per the national guidelines. Transplant patients and people in their household should also continue to practice good hand and respiratory hygiene:

Always carry tissues with you and use them to catch your cough or sneeze.
Wash your hands often with soap and water. Use a sanitiser gel if soap and water are not available.
Avoid touching your eyes, nose and mouth with unwashed hands.
Avoid close contact with people who are unwell.
Keep indoor areas well ventilated with fresh air, especially shared living areas.

Am I at increased risk?

There is increasing data on the risk of COVID-19 in patients who have had a cardiothoracic transplant. People who are immunocompromised following a transplant are known to be at increased risk of developing severe illness, according to data collected by NHS Blood and Transplant (NHSBT).

It seems reasonable to believe that all patients who have had a transplant will be at increased risk of severe infection especially if they have established graft damage that has occurred since transplant or another risk factor (age, ethnicity, obesity, co-morbidity such as kidney dysfunction).

Evidence suggests that wearing a face covering can reduce the spread of COVID-19. All patients attending the transplant clinic are advised to wear a mask in the transplant clinic area. Please note that wearing a mask is no longer mandated for other hospital areas, some of which will be in the vicinity of the transplant clinic. If you do not bring a face covering with you, you will be given one on arrival by a staff member.

What should I do if I feel unwell?

The symptoms of COVID-19 can be similar to other problems experienced by patients who have had a transplant. You should monitor your symptoms closely, for example if you have had a lung transplant increased vigilance with spirometry is strongly advised.

If you have had a heart transplant, you should contact us in case you develop new symptoms such as as shortness of breath, cough, etc.

Whether you have symptoms, or you have no symptoms but have got a positive lateral flow test result, you must contact the transplant clinic for further guidance. You might be advised to start or increase your steroid dose, or have a course of antibiotics. Growing experience shows that transplant patients may not develop any symptoms, and may not need treatment. If you develop serious symptoms such as difficulty breathing, or your oxygen levels drop below 90%, call 999 immediately, and tell the operator that you are a transplant patient and have COVID-19.

Is there a treatment for COVID-19?

There are many clinical trials under way to explore different agents, and the treatments available are increasing as a result. There are some treatments available for hospitalised patients only. However, new COVID-19 treatments are now available on the NHS for the highest-risk patients who are not in the hospital. These have been shown to reduce hospitalisation and include intravenous neutralising monoclonal antibodies and oral antivirals.

Treatment information can be found here. Transplant patients must never receive nirmatrelvir and ritonavir (Brand name: Paxlovid) as treatment for COVID-19. This is due to a strong interaction with immunosuppressant drugs. Please get in touch with us if you have any queries or concerns.

What about the COVID-19 vaccine?

We know that by now most of our transplant patients have received their COVID-19 vaccines. However, if you haven’t, as your transplant team we strongly advise that you do. Currently, this means that if you haven’t received any vaccination doses, you must receive three primary doses and a booster (three months after your third vaccine). Further boosters may be advised in the future. Further information on third primary dose vaccination can be found here.

COVID-19 immunisation is encouraged by NHS Blood & Transplant and by the International Society for Heart and Lung Transplantation, in patients with advanced heart or lung disease and pulmonary vascular disease, or in those awaiting or following heart or lung transplantation, when a vaccine is locally available.

Vaccines offer protection if you catch the virus, to help prevent or reduce the severity of illness. Side effects from the COVID-19 vaccine are rare.

You may not be suitable for the vaccine immediately in the following cases. Please get in touch with us to discuss if:

you have had a heart/lung transplant within the last 6 months
you have had a significant increase in your immunosuppression recently such as ECP, TLI, Immunoadsorption, Rituximab or RATG
you have previously had severe allergic reactions to vaccines

It is important to note that vaccines alone are not as effective in heart and lung transplant patients.

For further information about COVID-19 vaccines, please visit: https://www.nhs.uk/conditions/coronavirus-covid-19/coronavirus-vaccination/coronavirus-vaccine/

What should I do if I think I have been in contact with someone with COVID-19?

Please let your clinical team know so they can monitor you closely. If you start having symptoms, please undertake a lateral flow test immediately and let your transplant team know.

Should I self-isolate or work from home?

The government is no longer asking people to work from home if they can. However, if you need support to be able to work from home, please contact us and we will be happy to discuss this with you further.

What is known about the effectiveness of the COVID-19 vaccine in heart or lung transplant patients?

The effectiveness of the first COVID-19 vaccine (Pfizer/BioNTech) is impressive and in the range of more than 90%. Similarly, the effectiveness of the Oxford/AstraZeneca vaccine (currently awaiting approval) is in the range of 70%. In the small number of people who catch COVID-19 after having the vaccine - it appears to protect against severe COVID-19 infection and complications.

We do not yet know how long the vaccine provides protection against infection, but so far antibodies appear to be present at 4 months after vaccination.

Based on the MELODY study, vaccination in immunosuppressed patients shows satisfactory immunogenicity (the protective response to vaccine).

Should I have the vaccine even if I had COVID-19?

The current guidance is for everyone to receive the vaccine, even if you have had COVID-19 infection. The same applies if you previously had positive antibodies for COVID-19.

There are case reports of COVID-19 reinfection in immunocompromised patients which means that either protection after a first infection is inadequate or decreases with time.