Prior studies have demonstrated a decreased humoral response in solid organ transplant recipients (SOTRs) to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) messenger RNA (mRNA) vaccination (17% antibody response after dose 1 [D1], 54% after dose 2 [D2]) compared with the general population (100%).However, these studies were dominated by kidney transplant recipients and included only a small percentage of liver transplantation (LT) recipients (19.6%). (1)(2)(3)(4) Because LT recipients often receive milder induction and maintenance immunosuppression, they may have a more robust humoral response. To investigate this, we studied SARS-CoV-2 antibody development in a cohort of LT recipients who completed a 2-dose mRNA vaccine series of either mRNA-1273 (Moderna, Cambridge, MA) or BNT162b2 (Pfizer-BioNTech, New York, NY). Patients and MethodsInclusion criteria were post-LT patients with no reported prior positive SARS-CoV-2 polymerase chain reaction result. Participants were excluded if they were younger than 18 years old. Participants were recruited via convenience sampling through social media or transplant center advertisements and if they completed a 2-dose mRNA vaccine course between January 7, 2021, and March 26, 2021 and were followed through April 7, 2021. Data on demographics, body mass index (BMI), prior COVID-19 diagnosis, hospitalization, transplant information, medications, other immune conditions, and allergies were collected. The study had institutional review board approval, and informed consent was obtained. The blood sampling protocol used 2 SARS-CoV-2 spike protein immunoassays (EUROIMMUN [Lubek, Germany] to the subunit 1 [S1] domain and Roche Elecsys [Indianapolis, IN] to the receptor binding domain [RBD] of the SARS-CoV-2 spike protein) and has been described elsewhere. (1) We have shown in prior work that the distribution of vaccine responses did not differ when using the anti-S1 or anti-RBD assay. (4) The post-D1 assay was performed as close to D2 as possible, and the post-D2 assay was collected as close to 28 days as possible. Of note, the Roche assay is artificially truncated at >250 U/mL.

IMPORTANCETraditionally, liver transplant (LT) for alcohol-associated liver disease (ALD) requires 6 months of abstinence. Although early LT before 6 months of abstinence has been associated with decreased mortality for decompensated ALD, this practice remains controversial and concentrated at a few centers. OBJECTIVE To define patient, allograft, and relapse-free survival in early LT for ALD, and to investigate the association between these survival outcomes and early vs standard LT. DESIGN, SETTING, AND PARTICIPANTSThis cohort study analyzed all patients with ALD who underwent their first LT at a single academic referral center between October 1, 2012, and November 13, 2020. Patients with known pretransplant hepatocellular carcinoma, hepatitis B or C, or an alternative cause of liver failure were excluded. Follow-up period was defined as the time from LT to the most recent encounter with a transplant center or death.EXPOSURES The exposure of interest was early LT, which was defined as less than 180 days of pre-LT abstinence. Standard LT was defined as 180 days or more of pre-LT abstinence. Patients were separated into early LT and standard LT by time from abstinence to LT. MAIN OUTCOMES AND MEASURESThe outcomes were patient, allograft, relapse-free, and hazardous relapse-free survival for patients who underwent early LT or standard LT. These groups were compared by log-rank testing of Kaplan-Meier estimates. Hazardous relapse was defined as binge, at-risk, or frequent drinking. Abstinence was reassessed at the most recent follow-up visit for all patients. RESULTSOf the 163 patients with ALD included in this study, 88 (54%) underwent early LT and 75 (46%) underwent standard LT. This cohort had a mean (SD) age at transplant of 52 (10) years and was predominantly composed of 108 male patients (66%). Recipients of early LT vs standard LT were younger (median [interquartile range (IQR)] age, 49.7 [39.0-54.2] years vs 54.6 [48.7-60.0] years; P < .001) and had a higher median (IQR) Model for End-stage Liver Disease score at listing (35.

Coronavirus Disease-2019 (COVID-19) has profoundly affected the United States (US) health care system. [1][2][3][4] Given the novelty of the disease, there is tremendous uncertainty about the potential impact on transplant candidates and recipients. Early in the pandemic, transplant centers and patients had reservations about the reliable detection of Severe Acute Respiratory Syndrome Coronavirus 2