Humoral Immune Response following SARS-CoV-2 Vaccination in Liver Transplant Recipients

Abstract

As COVID-19 remains an issue in transplantation medicine, a successful vaccination can prevent infections and life-threatening courses. The probability of poor immune response in liver transplant recipients gained attention and insecurity among those patients, leading us to investigate the humoral immune response alongside the influence of underlying diseases and immunosuppressive regimen on seroconversion rates. We included 118 patients undergoing anti-spike-protein-IgG testing at least 21 days after completed SARS-CoV-2 vaccination. Ninety-seven patients also underwent anti-spike-protein-IgA testing. The influence of baseline demographics, immunosuppressive regimen and underlying disease on seroconversion was analyzed, and 92 of 118 patients (78.0%) developed anti-spike-protein-IgG antibodies. Patients with a history of alcoholic liver disease before transplantation showed significantly lower seroconversion rates (p = 0.006). Immunosuppression also significantly influenced antibody development (p < 0.001). Patients run on a mycophenolate mofetil (MMF)-based regimen were more likely not to develop antibodies compared to patients run on a non-MMF regimen (p < 0.001). All patients weaned off immunosuppression were seropositive. The seroconversion rate of 78.0% in our cohort of liver transplant recipients is promising. The identification of alcohol-induced cirrhosis as underlying disease and MMF for immunosuppression as risk factors for seronegativity may serve to identify vaccination non-responder after liver transplantation.

Mycophenolate mofetil decreases humoral responses to three doses of SARS‐CoV‐2 vaccine in liver transplant recipients

“…In their study, patients were not classified according to antibody levels, even though it is now known that poor responders to vaccination are at risk of severe COVID‐19 disease. 10 To our knowledge, there is no prospective study evaluating the MMF discontinuation before vaccination on the humoral response in LT recipients. Previously, the link between MMF and more severe COVID disease has been demonstrated.…”

“…In our study, MMF was a strong modifiable risk factor for a lack of vaccine response (OR 0.458, 95%CI 0.258–0.813; p = .008), consistent with previous studies of heterogeneous SOT groups. 21 , 22 Recently, Timmermann et al reported vaccine responses in 118 liver transplant patients after two doses, of whom 92 developed anti‐spike protein IgG antibodies (78%), 10 with alcohol‐induced cirrhosis and MMF risk factors for a failure to develop antibodies after vaccination. In their study, patients were not classified according to antibody levels, even though it is now known that poor responders to vaccination are at risk of severe COVID‐19 disease.…”

Cumulative Incidence of SARS-CoV-2 in Healthcare Workers at a General Hospital in Germany during the Pandemic—A Longitudinal Analysis

“…After the second vaccine dose, only one serological non-responder was found (0.3%). In the literature, non-responders are described in patients with immune deficiencies [ 38 , 39 , 40 ]. We found no study that investigated non-responders in HW.…”

Coronavirus Disease 2019 Vaccinations in Patients With Chronic Liver Disease and Liver Transplant Recipients: An Update

“…Three other prospective studies confirmed the poor antibody responses in patients with cirrhosis and even greater hyporesponsiveness in LT recipients ( 72 , 100 , 101 ). A study by Thuluvath et al ( 100 ) reported that 22.8% of patients with cirrhosis and 61.3% of LT recipients exhibited poor antibody responses after receiving two doses of mRNA vaccines or a single dose of the Johnson & Johnson vaccine.…”

“…Three other prospective studies confirmed the poor antibody responses in patients with cirrhosis and even greater hyporesponsiveness in LT recipients (72,100,101). A study by Thuluvath et al (100) (74).…”