@article{10902/32110,
year = {2023},
url = {https://hdl.handle.net/10902/32110},
abstract = {Background: Vaccine hesitancy and lack of access remain major issues in disseminating COVID-19 vaccination to liver patients globally. Factors predicting poor response to vaccination and risk of breakthrough infection are important data to target booster vaccine programs. The primary aim of the current study was to measure humoral responses to 2 doses of COVID-19 vaccine. Secondary aims included the determination of factors predicting breakthrough infection.
Methods: COVID-19 vaccination and Biomarkers in cirrhosis And post-Liver Transplantation is a prospective, multicenter, observational case-control study. Participants were recruited at 4-10 weeks following first and second vaccine doses in cirrhosis [n = 325; 94% messenger RNA (mRNA) and 6% viral vaccine], autoimmune liver disease (AILD) (n = 120; 77% mRNA and 23% viral vaccine), post-liver transplant (LT) (n = 146; 96% mRNA and 3% viral vaccine), and healthy controls (n = 51; 72% mRNA, 24% viral and 4% heterologous combination). Serological end points were measured, and data regarding breakthrough SARS-CoV-2 infection were collected.

Results: After adjusting by age, sex, and time of sample collection, anti-Spike IgG levels were the lowest in post-LT patients compared to cirrhosis (p < 0.0001), AILD (p < 0.0001), and control (p = 0.002). Factors predicting reduced responses included older age, Child-Turcotte-Pugh B/C, and elevated IL-6 in cirrhosis; non-mRNA vaccine in AILD; and coronary artery disease, use of mycophenolate and dysregulated B-call activating factor, and lymphotoxin-alpha levels in LT. Incident infection occurred in 6.6%, 10.6%, 7.4%, and 15.6% of cirrhosis, AILD, post-LT, and control, respectively. The only independent factor predicting infection in cirrhosis was low albumin level.

Conclusions: LT patients present the lowest response to the SARS-CoV-2 vaccine. In cirrhosis, the reduced response is associated with older age, stage of liver disease and systemic inflammation, and breakthrough infection with low albumin level},
organization = {This study was supported by unrestricted grants from the European Foundation for the Study of Chronic Liver Failure (UK) and the Foundation for Liver Research (UK). Ruben Sanchez-Aldehuelo Contrato received grants from the Instituto de Salud Carlos III Río Hortega (CM20/00020) and the Asociación Española para el Estudio del Hígado (ALEH) Beca para Aprendizaje de nuevas tecnologías 2022.},
publisher = {Wiley Periodicals, Inc. on behalf of the American Association for the Study of Liver Diseases},
publisher = {Hepatology Communications, 2023, 7(11), e0273},
title = {Serological response and breakthrough infection after COVID-19 vaccination in patients with cirrhosis and post-liver transplant},
author = {Mehta, Gautam and Riva, Antonio and Pilar Ballester, Maria and Uson, Eva and Pujadas, Montserrat and Carvalho-Gomes, Ângela and Sahuco, Ivan and Bono, Ariadna and Amico, Federico D' and Viganò, Raffaela and Diago, Elena and Tormo Lanseros, Beatriz and Inglese, Elvira and Martinez Vazquez, Dani and Sharma, Rajni and Phoebe Tsou, Hio Lam and Harris, Nicola and Broekhoven, Annelotte and Crespo García, Javier and Kokkert, Marjolein},
}