SARS‐CoV‐2 Infections Among Patients With Liver Disease and Liver Transplantation Who Received COVID‐19 Vaccination

Abstract

Many safe and effective severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccinations dramatically reduce risks of coronavirus disease 2019 (COVID‐19) complications and deaths. We aimed to describe cases of SARS‐CoV‐2 infection among patients with chronic liver disease (CLD) and liver transplant (LT) recipients with at least one prior COVID‐19 vaccine dose. The SECURE‐Liver and COVID‐Hep international reporting registries were used to identify laboratory‐confirmed COVID‐19 in CLD and LT patients who received a COVID‐19 vaccination. Of the 342 cases of lab‐confirmed SARS‐CoV‐2 infections in the era after vaccine licensing, 40 patients (21 with CLD and 19 with LT) had at least one prior COVID‐19 vaccination, including 12 who were fully vaccinated (≥2 weeks after second dose). Of the 21 patients with CLD (90% with cirrhosis), 7 (33%) were hospitalized, 1 (5%) was admitted to the intensive care unit (ICU), and 0 died. In the LT cohort (n = 19), there were 6 hospitalizations (32%), including 3 (16%) resulting in mechanical ventilation and 2 (11%) resulting in death. All three cases of severe COVID‐19 occurred in patients who had a single vaccine dose within the last 1‐2 weeks. In contemporary patients with CLD, rates of symptomatic infection, hospitalization, ICU admission, invasive ventilation, and death were numerically higher in unvaccinated individuals. Conclusion: This case series demonstrates the potential for COVID‐19 infections among patients with CLD and LT recipients who had received the COVID‐19 vaccination. Vaccination against SARS‐CoV‐2 appears to result in favorable outcomes as attested by the absence of mechanical ventilation, ICU, or death among fully vaccinated patients.

COVID-19 and liver disease

“…The same authors found that two doses of COVID-19 mRNA vaccine were associated with a lower incidence of COVID-19 infection, symptomatic COVID-19 and COVID-19-related death in LT recipients 140. In patients with CLD and LT recipients, vaccination against SARS-CoV-2 appears to result in favourable outcomes as attested by the absence of mechanical ventilation, ICU or death among fully vaccinated patients 141. Therefore, AASLD and EASL recommend prioritisation for vaccination of patients with CLD, including those with immune-mediated liver diseases, HCC and LT recipients 142 143.…”

“…The results of these studies on immunological response appear promising when contextualised in the current pandemic setting where hybrid immunity (mediated by infection and vaccine) becomes increasingly frequent. Encouraging data are available on the attenuation of severe forms in vaccine-LT-treated patients 158. However, considering that several reports have confirmed a low humoral-mediated and T cell-mediated response in patients with CLD and LT, a revised schedule of vaccine administration was advocated in these populations 159…”

Post-COVID-19 Cholestasis: A Case Series and Review of Literature

“…Currently, there is a lack of literature on the management of COVID-19 patients who develop chronic cholestasis after recovery. Furthermore, it is well known that vaccinations can prevent severe COVID-19 and improve outcomes 11 , 12 . However, the effect of vaccines on COVID-19 induced cholestasis is unknown.…”

Antibody response to the messenger RNA‐1273 vaccine (Moderna) in liver transplant recipients

“…These findings appear to be consistent with a recently published paper reporting that SARS‐CoV‐2 vaccination reduces severe disease in patients with cirrhosis and SOTRs. [ 32 ]…”