ABSTRACT
Background/Aims: Several studies showed that patients with liver cirrhosis have an immune dysregulation leading to poor immunological response to vaccination. However, in literature there are few data about the response to SARS-CoV-2 vaccination in patients with chronic liver disease (CLD). Aims of the study are (is) the evaluation of safety and immunogenicity of booster dose in patients with CLD. Methods: From September 2021 to April 2022, all consecutive outpatients with CLD who completed the primary vaccination course and the booster dose for anti-SARS-CoV-2 vaccination were enrolled. Blood samples were collected 12-16 weeks after second dose and after booster dose. Collected samples were analyzed for detecting anti-Spike protein IgG using LIAISON TrimericS IgG chemiluminescent assay (Diasorin, Italy). Results: We enrolled 340 patients (187 Males, mean age:64.32±17.34years). Stratified by the presence of cirrhosis, 249 had CLD and 91 were cirrhotic whose 57 (62.24%) had portal hypertension. At the end of the primary vaccination course, 60 patients (17.65%) did not develop a protective antibody titer, with no statistically significant differences between the two groups (19.7% in cirrhotic vs 16.8% in non-cirrhotic;p=0.076). The majority of them (53/60 patients;88.3%) developed a protective titer after booster dose, without differences between cirrhotics and non-cirrhotics (p=0.089). At multivariate analysis, factors associated with a higher humoral response after booster dose were young age (p=0.0098);porto-sinusoidal vascular disorder (p=0.005), none or a single comorbidity rather than two or more (p=0.05) and Spikevax booster dose compared with Comirnaty (p=0.001). Moreover, the antibody titer is inversely related to age (p=0.000). Conclusions: In a large cohort of patients with CLD booster dose of anti-Sars-CoV-2 vaccine has an excellent immunogenicity and leads to an adequate antibody response even in those who had not produced a protective titer after the primary vaccination course. Cirrhosis is not associated with a reduced humoral response.
ABSTRACT
Introduction: In the context of the Italian SARS-CoV-2 vaccination program, liver transplant (LT) recipients were prioritized for vaccine administration, although the lower response to vaccines is a well known problem in this population. Aim: We aimed to evaluate immunogenicity of BNT162b2 mRNA vaccine in LT recipients and healthy controls and to identify factors associated with negative response to vaccine. Materials and Methods: We prospectively evaluated a cohort of adult LT patients the humoral response (with anti-Spike protein IgG-LIAISON SARS-CoV-2 S1/S2-IgG chemiluminescent assay) at 1 and 3 months after 2-dose vaccination. A group of 307 vaccinated healthcare workers, matched by age and sex, served as controls. Results: Overall, 492 LT patients were enrolled (75.41% male, median age 64.85 years). Detectable antibodies were observed in the 75% of patients with a median value of 73.9 AU/mL after 3 months from 2-dose vaccination. At multivariable analysis, older age (>40years, p=0.016), shorter time from liver transplantation (<5years, p=0.004), and immunosuppression with antimetabolites (p=0.029) were significantly associated with non-response to vaccination. Moreover, the LT recipients showed antibody titers statistically lower than the control group (103 vs 261 AU/ml, p<0.0001) (fig. 1). Finally, both in controls and LT patients we found a trend of inverse correlation between age and antibody titers (correlation coefficient: -0.2023 and -0.2345, respectively). Conclusions: Three months after vaccination, LT recipients showed humoral response in 75% of cases. Older age, shorter time from transplantation and use of antimetabolites were factors associated with non-response to vaccination and needed to be kept under close monitoring.
ABSTRACT
Background and aim: Liver transplant (LT) recipients are clinically vulnerable to SARS-CoV-2 infection, due to immunosuppression and comorbidities. Aim of this study was to evaluate the impact of COVID-19 on LT recipients compared to general population in Southern Italy (Campania region). Materials and methods: In this case-control double-center study, we enrolled all consecutive adult liver recipients with confirmed SARS-CoV-2 infection. Data were collected at diagnosis of COVID-19 and during follow-up and compared with the Campania regional population (extracted by National Health System COVID-19 database – https://covid-19.iss.it). Results: A total of 30 LT patients developed Sars-CoV-2 infection (76.6% male, median age 62.6yrs). Sixteen (53.3%) were symptomatic;no differences in LT indications, immunosuppression and comorbidities were found between asymptomatic and symptomatic patients. Common COVID-19 symptoms were fever (46.6%), cough (36.6%), fatigue (36.6%) and anosmia (36.6%). Twenty-five (83.4%) patients were managed at home, while 5 (16.6%) required hospitalization (2 were admitted to ICU, 2 developed ARDS and 2 died). Immunosuppressors were modified only in hospitalized patients incidence rate of Sars-CoV-2 infection was similar between LT patients and general population (3.28% vs 4.37%, p=0.1) while symptomaticity rate was higher in LT patients (46.67% vs 15.87%, p<0.00). Hospitalization rate was higher in LT patients than in general population (16.67% vs 4.54%, p=0.001), with similar median length of stay (11 vs 20 days, p=0.32). Lethality rate was higher in LT patients than in general population (6.67% vs 1.76%, p=0.041). According to the multivariable logistic regression analysis, age (fully adjusted-OR 1.02 [95% CI 1.00-1.04], p=0.005) and female sex (fully adjusted-OR 0.31 [95% CI 0.13-0.73], p=0.007) showed positive and negative association, Sars-CoV-2 infection in LT patients. In fully adjusted model, LT patients are more frequently symptomatic (OR 5.44 [95% CI 2.44-12.17], p<0.00), while hospitalization and death for COVID-19 are not significatively associated with liver transplant and p=0.46, respectively). Conclusions: Our study showed that the vulnerability of the LT patients is not a risk factor for acquiring SARS-CoV-2 infection. Nonetheless, LT patients are more frequently symptomatic, although they are comparable to the general population in terms of hospitalization and lethality.