Poor immune response to coronavirus disease vaccines in decompensated cirrhosis patients and liver transplant recipients

Kulkarni, Anand V.; Jaggaiahgari, Shashidhar; Iyengar, Sowmya; Simhadri, Venu; Gujjarlapudi, Deepika; Rugwani, Hardik; Vemula, Venkata Krishna; Gora, Baqar Ali; Shaik, Sameer; Sharma, Mithun; Sasikala, Mitnal; Padaki, Nagaraja Rao; Reddy, K. Rajender; Reddy, Duvvur Nageshwar

doi:10.1016/j.vaccine.2022.10.042

Cited by 8 publications

(13 citation statements)

References 37 publications

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“…Studies investigating the vaccine-induced immune response in patients with cirrhosis following vaccination against other pathogens, such as HBV or influenza virus, suggest an impaired humoral immune response in decompensated cirrhosis 107 108. This is also the case for SARS-CoV-2, where the antibody response was particularly weak in decompensated patients104 106 109 (figure 3A,B). The impaired humoral immune response in these patients may be explained by an altered cytokine phenotype with higher levels of proinflammatory cytokines such as IL-2 or IL-6 in advanced cirrhosis 110.…”

Section: Sars-cov-2 and The Adaptive Immune Responsementioning

confidence: 88%

SARS-CoV-2 and the liver: clinical and immunological features in chronic liver disease

Luxenburger

Thimme

2023

Gut

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SARS-CoV-2 infection may affect the liver in healthy individuals but also influences the course of COVID-19 in patients with chronic liver disease (CLD). As described in healthy individuals, a strong SARS-CoV-2-specific adaptive immune response is important for the outcome of COVID-19, however, knowledge on the adaptive immune response in CLD is limited.Here, we review the clinical and immunological features of SARS-CoV-2 infection in individuals with CLD. Acute liver injury occurs in many cases of SARS-CoV-2 infection and may be induced by multiple factors, such as cytokines, direct viral infection or toxic effects of COVID-19 drugs. In individuals with CLD, SARS-CoV-2 infection may have a more severe course and promote decompensation and particularly in patients with cirrhosis. Compared with healthy individuals, the SARS-CoV-2-specific adaptive immune responses is impaired in patients with CLD after both, natural infection and vaccination but improves at least partially after booster vaccination.Following SARS-CoV-2 vaccination, rare cases of acute vaccine-induced liver injury and the development of autoimmune-like hepatitis have been reported. However, the concomitant elevation of liver enzymes is reversible under steroid treatment.

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Section: Sars-cov-2 and The Adaptive Immune Responsementioning

confidence: 88%

SARS-CoV-2 and the liver: clinical and immunological features in chronic liver disease

Luxenburger

Thimme

2023

Gut

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“…In contrast with the study from John BV et al, antibody responses after adenovirus-based vaccines were poorer when compared with mRNA-based vaccines, especially in patients with decompensated cirrhosis, in two other studies [ 43 , 58 ]. More specifically, Thuluvath P., et al showed poorer antibody responses in patients with cirrhosis receiving the Ad.26.COV2.S vaccine when compared with those receiving the mRNA vaccines; however only seven PWLC received the Ad.26.COV2.S vaccine in this study [ 43 ].…”

Section: Viral Vector-based Vaccinesmentioning

confidence: 63%

“…More specifically, Thuluvath P., et al showed poorer antibody responses in patients with cirrhosis receiving the Ad.26.COV2.S vaccine when compared with those receiving the mRNA vaccines; however only seven PWLC received the Ad.26.COV2.S vaccine in this study [ 43 ]. Likewise, in a study by Kulkarni A et al, patients with decompensated cirrhosis showed suboptimal humoral and cellular immune responses after ChAdOx1 vaccination [ 58 ]. More specifically, 34% of patients with decompensated cirrhosis were non-responders, while CD4-naïve, CD4 effector, B- and B-memory cells were lower in patients with decompensated cirrhosis [ 58 ].…”

Section: Viral Vector-based Vaccinesmentioning

confidence: 99%

“…Likewise, in a study by Kulkarni A et al, patients with decompensated cirrhosis showed suboptimal humoral and cellular immune responses after ChAdOx1 vaccination [ 58 ]. More specifically, 34% of patients with decompensated cirrhosis were non-responders, while CD4-naïve, CD4 effector, B- and B-memory cells were lower in patients with decompensated cirrhosis [ 58 ]. In agreement with the previous studies, no severe adverse events were recorded, confirming the safety of viral vector-based vaccines in PWLC.…”

Section: Viral Vector-based Vaccinesmentioning

confidence: 99%

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Efficacy, Safety and Immunogenicity of Anti-SARS-CoV-2 Vaccines in Patients with Cirrhosis: A Narrative Review

2023

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19), has led to a pandemic with more than 6.5 million deaths worldwide. Patients with liver cirrhosis (PWLC) are regarded as prone to severe COVID-19. Vaccination against SARS-CoV-2 has been proven to be the most effective measure against COVID-19 and a variety of different vaccines have been approved for use; namely mRNA and vector-based, inactivated, whole virion, and protein subunit vaccines. Unfortunately, only a small number of PWLC were included in phase I–III vaccine trials, raising concerns regarding their efficacy and safety in this population. The authors, in this review, present available data regarding safety and efficacy of anti-SARS-CoV-2 vaccination in PWLC and discuss post-vaccination antibody responses. Overall, all vaccines seem to be extremely safe, with only a few and insignificant adverse events, and efficient, leading to lower rates of hospitalization and COVID-19-related mortality. T- and B-cell responses, on the other hand, remain an enigma, especially in patients with decompensated disease, since these patients show lower titers of anti-SARS-CoV-2 antibodies in some studies, with a more rapid waning. However, this finding is not consistent, and its clinical impact is still undetermined.

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“…[1] Compared with compensated cirrhosis, decompensated cirrhosis (especially for severe grade) is associated with a higher risk of COVID-19 infection and vaccine hyporesponsiveness. [4,5] Therefore, to fully explore the association between cirrhosis and BSI, it is necessary to supplement the subgroup analysis of decompensated cirrhosis and further stratified analysis according to different decompensated classifications. There is a possibility that the severe decompensated cirrhosis is associated with a higher risk of BSI than noncirrhotic patients with CLD.Finally, the number "10,441" in the "Approach and Results" subsection of the "Abstract" section should be corrected with the number "10,241" because "10,241" is the number of vaccinated CLD patients with cirrhosis, while "10,441" is the number of unvaccinated CLD patients with cirrhosis and SARS-CoV-2 infection.…”

mentioning

confidence: 99%

Letter to the Editor: What is the actual role of decompensated cirrhosis in the breakthrough SARS-CoV-2 infection?

Hu,

Li,

et al. 2023

Hepatology

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Poor immune response to coronavirus disease vaccines in decompensated cirrhosis patients and liver transplant recipients

Cited by 8 publications

References 37 publications

SARS-CoV-2 and the liver: clinical and immunological features in chronic liver disease

SARS-CoV-2 and the liver: clinical and immunological features in chronic liver disease

Efficacy, Safety and Immunogenicity of Anti-SARS-CoV-2 Vaccines in Patients with Cirrhosis: A Narrative Review

Letter to the Editor: What is the actual role of decompensated cirrhosis in the breakthrough SARS-CoV-2 infection?

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