Seroconversion After Coronavirus Disease 2019 Vaccination in Patients Awaiting Liver Transplantation: Fact or Fancy?

Abstract

Chronic liver disease increased the risk of severe coronavirus disease 2019 (COVID‐19). Trials to assess efficacy/safety of COVID‐19 vaccines in liver disease are underway. We evaluated the humoral immune response and safety of anti–COVID‐19 vaccination among patients waiting liver transplantation (LT). We enrolled all pre‐LT adults who completed anti‐COVID‐19 vaccination between January 2021‐August 2021 as study group. Patients with histories of COVID‐19 received 1 vaccine dose, and all others received 2 doses. Patients were tested for COVID‐19 immunoglobulin G (IgG) within 1 and 2 months after vaccination. Safety was evaluated with telephone interviews/outpatient visits. A control group of 30 healthcare workers who underwent vaccination in January 2021 and tested for IgG after 4 months was included. In the 89 pre‐LT patients, at T1 (23 days after vaccination), seroconversion rate was 94.4%, and median IgG value was 1980 binding antibody units/mL (interquartile range 646‐2080), and at T2 (68 days after vaccination) was 92.0%, with IgG value of 1450 (577‐2080); (T1 versus T2, P = 0.38). In the 10/89 patients who received 1 vaccine dose, the median IgG value was 274 (68‐548) before vaccine (T0), 2080 (1165‐2080) at T1, and 2030 (964‐2080) at T2 (T0 versus T1, P = 0.03; T1 versus T2, P = 0.99). All controls tested positive at 4 months after vaccination, with a median value of 847 (509‐1165; P < 0.001 versus T1 and P = 0.04 versus T2 in the study group). No serious adverse event was reported in both groups. Our data from 89 pre‐LT patients suggest a high rate of immunization (94.4%) after a median time of 23 days from safe COVID‐19 vaccine. None of the patients developed COVID‐19.

Differences in Humoral and Cellular Vaccine Responses to SARS-CoV-2 in Kidney and Liver Transplant Recipients

“…In particular, data indicate that uremia associates with increased T cell exhaustion ( 28 ) and low response to vaccines ( 29 ), which could, at least partially, explain, the impaired serological responses to SARS-CoV-2 vaccines in kidney transplant recipients, as well as in patients with kidney failure ( 30 , 31 ). Consistent with this hypothesis, response to SARS-CoV-2 vaccine in patients with liver failure is not significantly impaired ( 32 ).…”

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

“…In patients with non-alcoholic fatty liver disease (NAFLD), seropositivity rates of 95.5% were described [ 20 ]. In patients with liver cirrhosis, Thuluvath et al reported a seroconversion of 95.9% in a group of 79 patients with liver cirrhosis [ 21 ], and Calleri et al observed a seroconversion rate of 94.4% in 89 pre-transplant patients [ 22 ].…”

Comportamiento de las enfermedades hepáticas en una cohorte de pacientes colombianos con COVID 19

“…Únicamente se encontró un registro de un paciente trasplantado, lo que deja abierta la puerta a la investigación en este grupo de pacientes, quienes ya tienen un mayor riesgo de mortalidad por cualquier causa debido a que son pacientes inmunosuprimidos; sin embargo, esto refuerza el concepto de la protección con la inmunización ya que este grupo de pacientes tiene una menor respuesta inmunogénica (50 % aproximadamente), a diferencia de aquellos inmunocompetentes con respuestas cercanas al 94 % (18,19) .…”