ABSTRACT
Background: COVID-19 is associated with thrombotic complications and can result in hepatobiliary injury. Excellent early outcomes have been reported in recipients of solid non-lungs organs from SARS-CoV-2-infected donors, however longer follow-up data are lacking. We aimed to describe the medium-term outcome of our liver transplants (LT) from COVID-19 donors. Methods: From 11/2020 to 03/2022, we consecutively enrolled all patients who received a graft from COVID-19 donor in our Centre. Protocol liver biopsy and magnetic resonance cholangiopancreatography (MRCP) after 1-year from LT were reported. Results: In the study period 12/213 (5.6%) adult LT patients received a COVID-19 donor (11 active, 1 resolved COVID-19)1. Eleven patients underwent end-to-end biliary anastomosis and 1 biliodigestive anastomosis. Recipients' and donors' characteristics are reported in table 1. Two recipients tested SARS-CoV-2 RNA positive on nasopharyngeal swab at LT and one was treated with sotrovimab on day-1 after LT. None of the patients developed COVID-19 after LT. One patient underwent hepatic artery thrombectomy at day-1 and died after 320 days for HCC recurrence. Until now: -10 patients underwent protocol MRCP (median time from LT 562 days, IQR 245-614), which showed: 7 no visible abnormalities, 1 donor-recipient's bile duct size discrepancy, 2 caliber changes <50% at the anastomotic level (untreated for the absence of cholestasis);-7 patients underwent protocol liver biopsy (median time from LT 553 days, IQR 311-557) which showed 1 acute cellular rejection (RAI 4/9) successfully treated with steroids;no signs of fibrosis, rejection or biliopathy in the other 6 patients. Conclusions: 11/12 patients who received a LT from COVID-19 donors are alive, without evidence of SARS-CoV-2 transmission. At a median follow-up of 1.5 years, protocol liver biopsy and MRCP did not show biliopathy, supporting the utilization of COVID-19 donors to expand the donor pool and reduce the waiting list mortality.
ABSTRACT
Introduction: Anti-SARS-CoV-2 vaccines demonstrated a high rate of success in preventing severe COVID-19 and decreasing infection rate. Few data are available in pre-liver transplant (LT) patients. IgG anti-Spike reflect humoral response to vaccination. Aims: We aimed to evaluate longevity of humoral response to mRNA vaccine in our pre-LT patients. Methods: From 01/2021 to 10/2021 we enrolled all pre-LT patients who completed anti-SARS-CoV-2 mRNA vaccination. Patients with previous COVID-19 received 1 vaccine dose within 6 months after infection. All the others received 2 doses. Patients were tested for IgG (LIAISON® SARS-CoV-2 TrimericS, positivity≥33.8 BAU/mL) 1 month post-vaccination and then every 2 months until LT. Results: During study period, 91 pre-LT patients completed anti-SARS-CoV-2 vaccination: 80 patients received 2 doses, 11 patients 1 dose, as per protocol (94% Pfizer-BioNTech, 6% Moderna-COVID-19). 69% male, median age 56 years, BMI 25kg/m2, eGFR 95ml/min, MELD 12;43% HCC;6 patients on steroids for autoimmune cirrhosis. 23 days post-vaccination (T1), 86/91 (95%) seroconverted (median titer 1970 BAU/mL). During follow-up none of retested patients became IgG negative, however their titer progressively dropped: 72 days post-vaccination (T2), 61/64 (95%) tested again IgG positive (median titer 1480);at T3 (113 days post-vaccination) 42/43 (98%) patients remained positive and their titer significantly decreased (779);23 pts were retested at T4 (140 days post-vaccination) and all of them remained IgG positive (median titer 320). (T1vsT2, p=0.22;T2vsT3 p<0.001;T3vsT4, p=0.02;T1vsT4, p=0.008). At the end of a median follow-up of 190 days from vaccination, none of the patients developed COVID-19. No serious adverse events were registered. Conclusions: In our 91 pre-LT patients, mRNA anti-SARS-CoV-2 vaccination elicited a high rate of seroconversion (95%) within 1 month. We observed a progressive significant decrease in IgG titer during a median follow-up of 190 days after vaccination. Nevertheless, none of our pre-LT patients developed COVID-19. [Formula presented]
ABSTRACT
Background: Severe complications of COVID-19 observed in patients with liver cirrhosis might be partly explained by their immune dysfunction, which can also account for to the impaired response to existing vaccinations. Anti SARS-CoV-2 vaccine development has progressed at an unprecedented rate, with phase 3 trial data offering the prospect of achieving herd immunity. Despite the inclusion of 100,000 participants in these trials, data for patients with liver disease are scanty. In our study we described SARS-CoV-2 IgG response rate after vaccination and vaccine reaction in cirrhotic patients awaiting liver transplant. Methods: We enrolled all patients waiting for liver transplant who completed anti COVID-19 vaccination between January and June 2021, in our Center. According to our National Health Care System recommendations, patients with a previous documented COVID-19 received a single vaccine dose, within 6 months after infection. All other patients received 2 doses, administered 3 weeks apart. Patients were tested for SARS-CoV-2 IgG antibodies (LIAISON® SARS-CoV-2 TrimericS IgG assay, positive ≥33.8 BAU/mL) within one month after anti SARSCoV-2 mRNA vaccination (Comirnaty, Pfizer-BioNTech). Results: At the beginning and at the end of the enrollment period, 76 and 73 adult patients were on the liver transplant waiting list, respectively. Fifty of them completed anti COVID-19 vaccination and were suitable for the enrollment in the study. The median age of the patients was 56 years (IQR 52-61), 76% were male, median BMI 24.7 kg/m2 (IQR 23-27), 42% was blood type 0. Viral etiology 44%, alcoholrelated 20% and NAFLD 8%. 50% of the patients showed hepatocellular carcinoma (HCC). Median MELD score at the entry on the liver transplant waiting list was 8 (7-11), while in non-HCC patients MELD score was 13 (10-18). Median creatinine clearance was 96 mL/min. 46 out of 50 patients (92%) received 2 doses of vaccine, while 4 out of 50 (8%) received only 1 dose, as per described protocol. SARS-CoV-2 IgG were tested after a median time of 19 days (IQR 9-28) since vaccination. 45 out of 46 patients (97.8%) who received 2 doses, became IgG anti SARS-CoV-2 positive (median value 1,599 BAU/mL, IQR 669-2,080). The 4 patients injected with only 1 dose were IgG anti SARS-CoV-2 positive at baseline (median value 291 BAU/mL, IQR 65-548) and they increased their titer after vaccination (median value 1,530 BAU/mL, IQR 829-1997). No patient experienced severe adverse reactions, and none tested positive for SARS-CoV-2 infection after vaccination. Conclusion: In our cohort of 50 adult compensated cirrhotic patients awaiting liver transplant (50% with HCC), 98% produced high levels of neutralizing IgG anti SARS-CoV-2 antibodies after a median time of 19 days from mRNA vaccination. This excellent immunization rate is consistent with data reported in the healthy population.