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SARS-CoV-2 vaccine alleviates disease burden and severity in liver transplant recipients even with low antibody titers.
Khalaileh, Abed; Imam, Ashraf; Jammal, Alaa; Hakimian, David; Amer, Johnny; Shafrir, Asher; Milgrom, Yael; Massarwa, Muhammad; Hazou, Wadi; Khader, Majd; Safadi, Rifaat.
  • Khalaileh A; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
  • Imam A; Department of Surgery, Hadassah Medical Center, Jerusalem, Israel.
  • Jammal A; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
  • Hakimian D; Department of Surgery, Hadassah Medical Center, Jerusalem, Israel.
  • Amer J; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
  • Shafrir A; The Liver Institute, Hadassah Medical Center, Jerusalem, Israel.
  • Milgrom Y; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
  • Massarwa M; The Liver Institute, Hadassah Medical Center, Jerusalem, Israel.
  • Hazou W; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
  • Khader M; The Liver Institute, Hadassah Medical Center, Jerusalem, Israel.
  • Safadi R; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Hepatol Commun ; 7(2): e0025, 2023 02 01.
Article in English | MEDLINE | ID: covidwho-2222831
ABSTRACT
BACKGROUND AND

AIMS:

We retrospectively assessed the clinical Pfizer's mRNA SARS-CoV-2 BNT162b2 vaccination outcomes and the serologic impact on liver transplant (LT) recipients. PATIENTS AND

METHODS:

One hundred and sixty-seven LT cases followed between March 1, 2020 and September 25, 2021, and were stratified into two groups (1) 37 LT recipients after SARS-CoV-2 infection before vaccine era and (2) 130 LT recipients vaccinated with 2 doses without earlier SARS-CoV-2 exposure. Serum SARS-CoV-2 spike immunoglobulins (anti-S) were assessed 7 days following vaccination (Liaison assay).

RESULTS:

In addition to the 37 nonvaccinated cases (22.2% of total group) who experienced SARS-CoV-2 infection (34 symptomatic and 3 asymptomatic), another 8 vaccinated symptomatic recipients (4.8%) were infected (5 from the third and three from the fourth waves). Three of the 45 infected cases died (6.7%) before the vaccine program. Vaccinated group of the 130 LT vaccinated recipients, 8 (6.2%) got infected postvaccination (added to the infected group) and were defined as clinical vaccine failure; 38 (29.2%) were serological vaccine failure (total failure 35.4%), and 64.6% cases were serological vaccine responders (anti-S≥19 AU/mL). Longer post-LT interval and lower consumption of immunosuppressants (steroids, FK506, and mycophenolate mofetil) correlated with favorable SARS-CoV-2 vaccine response. Mammalian target of rapamycin inhibitors improved vaccine outcomes associated with lower FK506 dosages and serum levels. Patients with anti-S levels <100 AU/mL risked losing serologic response or being infected with SARS-CoV-2. A booster dose achieved an effective serologic response in a third of failures and most responders, securing better and possibly longer protection.

CONCLUSION:

Pfizer's BNT162b2 vaccine seems to lessen SARS-CoV-2 morbidity and mortality of LT recipients even with weak serological immunogenicity. Switching mycophenolate mofetil to mammalian target of rapamycin inhibitors might be effective before boosters in vaccine failure cases. A booster vaccine should be considered for nonresponders and low-responders after the second dose.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Liver Transplantation / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid / Vaccines Limits: Humans Language: English Journal: Hepatol Commun Year: 2023 Document Type: Article Affiliation country: HC9.0000000000000025

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Liver Transplantation / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid / Vaccines Limits: Humans Language: English Journal: Hepatol Commun Year: 2023 Document Type: Article Affiliation country: HC9.0000000000000025