ABSTRACT
Background: Suboptimal anti-Sars-Cov2 vaccine response has been demonstrated during immunosuppressive treatments. Liver Transplant Recipients (LTRs) and Inflammatory Bowel Disease (IBD) patients are different setting of populations who are both undergoing immunosuppressive treatments. In this work, we pooled and compared, retrospectively, these two populations to evaluate anti-SARS-CoV2 seroconversion after the second dose of vaccination. Different comorbidities and therapies outcomes have been explored as well. Method(s): The antibody titres standardized of the two cohorts have been analysed. Matched patients of both populations for comorbidities and therapies with application of propensity score have been investigated. Result(s): 240 LTRs and 424 IBD patients were analysed. Most have received an mRNA based vaccine (BNT162b2 or mRNA-1273: 99.1%). The seroconversion rate of 84% for LTRs and 93% for IBD patients was recorded. To multivariate analysis, hypertension (OR 2.8618, 95% CI 1.0012 to 8.1802), the mycophenolate administration (OR 2.9733, 95% CI 1.1820 to 7.4794) and the steroid use (OR 5.4531, 95% CI 1.0706 to 27.7761) were significantly associated with reduced seroconversion in LTRs cohort;meanwhile, the older age (OR 1.0369, 95% CI 1.0076 to 1.0670) and the thiopurine consumption (OR 2.9484, 95% CI 1.0089 to 8.6166) with that in IBD population. After Propensity Score Matching application, the seroconversion rates, not statistically different, of 86% for LTRs and 92% for IBD patients were found. Hypertension (OR 2.73, 95%CI 1.1258 to 6.6138), diabetes (OR 3.16, 95% CI 1.1888 to 8.4217), age > 65y (OR 2.93, 95% CI 1.1712 to 7.3153) and the female sex (OR 2.54, 95% CI 1.0963 to 5.9104) were correlated with reduced seroconversion in both populations. Conclusion(s): After Propensity Score Matching, the seroconversion rates of IBD and LTR patients were not statistically different. Hypertension, diabetes and age > 65y revealed a significant influence on seroconversion and the female showed a reduced seroconversion in comparison to male.
ABSTRACT
Background and aims: Solid organ transplant recipients (SOTRs) have been considered as an extremely vulnerable population in respect to SARS-CoV-2 infection. We aimed to assess the incidence and lethality rate of SARS-CoV-2 infection in different organ transplant settings using the liver as a comparator. Methods: In this nationwide population-based study we compared the crude incidence and lethality rates of SARS-CoV-2 infection [95% Bonferroni adjusted CI (Ba-CI)] among Italian LTRs as compared to non-liver SOTRs and to general population. The following independent groups had been compared: Italian general population, all SOTRs, liver transplant recipients (LTRs) and non-Liver SOTRs in area with different incidence of infection. Incidence rate ratio (IRR) and lethality rate ratio (LRR) was assessed. Community risk exposures in transplant settings were assessed. Results: From February 21 to June 22, 2020, there were 450 cases of SARS-CoV-2 infections over 14168 LTRs (n=89) and 29815 non-liver SOTRs (n= 361). A significantly lower risk of infection [IRR 0.56 (Ba-CI 0.34-0.92), 0.45 (Ba-CI 0.26-0.79), 0.52 (Ba-CI 0.36-0.75)] and a lower lethality rate ratio [(LRR 0.61 (Ba-CI 0.23-1.57), 0.37 (0.08-1.76), 0.52 (0.23-1.18] was found among LTRs as compared to non-liver SOTRs in the three areas. Excluding Lombardy, the risk of infection and lethality in LTRs was lower compared to general population. Non-Liver SOTRs showed an increased risk of infection and lethality at all geographic levels compared to general population. No significant difference in the adherence to mitigation policies was found. Conclusions: Liver transplantation was associated with a significantly lower risk of SARS-CoV-2 infection and lethality in respect to non-liver solid organ transplants. A separate evaluation of organ-specific risk stratification analysis and vaccination responses in transplant population is needed.