Patients with Liver Cirrhosis Show High Immunogenicity upon COVID-19 Vaccination but Develop Premature Deterioration of Antibody Titers

Abstract

SARS-CoV-2 infection is known to lead to severe morbidity and mortality in patients with liver cirrhosis. For this reason, vaccination of these patients against COVID-19 is widely recommended. However, data regarding immunogenicity in patients with liver cirrhosis is limited and even less is known about the kinetics of antibody response, as well as the optimal timing of booster immunization. We analyzed immunogenicity in 110 patients with liver cirrhosis after receiving two doses of the mRNA-based vaccine BNT162b2 following the standard protocol and compared these results to a control group consisting of 80 healthcare workers. One hundred and six patients with liver cirrhosis (96%) developed antibodies against SARS-CoV-2, compared to 79 (99%) in the control group (p = 0.400). Still, the median SARS-CoV-2 IgG titer was significantly lower in patients with liver cirrhosis compared to the control group (939 vs. 1905 BAU/mL, p = 0.0001). We also analyzed the strength of the antibody response in relation to the time between the second dose and antibody detection. Antibody titers remained relatively stable in the control group while showing a rapid and significant decrease in patients with liver cirrhosis. In conclusion, our data reveals a favorable initial outcome after vaccination with the COVID-19 vaccine BNT162b2 in cirrhotic patients but show a rapid deterioration of the antibody response after time, thereby giving a strong hint towards the importance of early booster immunization for this group of patients.

Individuals With Weaker Antibody Responses After Booster Immunization Are Prone to Omicron Breakthrough Infections

“…Although a weaker immune response upon COVID-19 vaccination has been described for particular groups, like elderly or immune-compromised individuals ( 10 – 13 ), we observed differences in immune response independent from these factors. Genetic variations might explain some of the differences in the strength of innate immune response ( 14 ).…”

Antibody Response and Safety of ChAdOx1-nCOV (Covishield) in Patients with Cirrhosis: A Cross-Sectional, Observational Study

“…Some evidence suggests that the antibody titers induced by mRNA vaccines in patients with cirrhosis may be lower than that in healthy individuals without liver disease [ 26 ]. Further, Thuluvath et al reported suboptimal antibody responses in 19% patients with optimal antibody levels in 77.2% of 79 patients with cirrhosis [ 24 ].…”

Impact of COVID-19 on the liver and on the care of patients with chronic liver disease, hepatobiliary cancer, and liver transplantation: An updated EASL position paper

“…Vaccine immunogenicity Patients with CLD have been shown to have anti-SARS-CoV-2 S-spike IgG seroconversion rates of >85% following two vaccine doses [281]. However several studies have suggested that patients with cirrhosis may have a more rapid decline in antibody titers over time compared to healthy controls [281,282]. In contrast, LT recipients remain at high-risk for suboptimal humoral responses to vaccination.…”