Age, arterial hypertension predicts COVID-19 vaccine response in LT patients
Researchers recommended a third SARS-CoV-2 vaccination dose for liver transplant recipients and patients with cirrhosis who have a low or absent serological response.
“In initial clinical trials investigating the efficacy and safety of SARS-CoV-2 vaccines, various immunocompromised or immunosuppressed patient populations (ie, patients with liver cirrhosis (LC) or LT recipients) were not included. However, markedly increased mortality due to COVID-19 has been described for both patient groups compared to the healthy population,” Darius F. Ruether, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, and colleagues wrote. “Preliminary data showed that LT recipients might be less likely to reach seroconversion after SARS-CoV-2 vaccination, but up to now few detailed data are available on patients with cirrhosis.”
In a prospective, observational study, researchers aimed to explore the humoral and T-cell response to the SARS-CoV-2 vaccine among 194 patients (LC = 53; LT = 141) compared with 56 healthy control patients. Using immunoassays, they determined anti-SARS-CoV-2 spike-protein titers and spike-specific T-cell response prior to vaccination as well as 10 days to 84 days post-vaccination. Further, logistic regression identified predictors of low response.
Following the second vaccination, 63% of LT recipients, 100% of patients with cirrhosis and 100% of healthy control participants achieved seroconversion with lowered anti-SARS-CoV-2 titers present among LT recipients. Further results demonstrated spike-specific T-cell response rates of 36% in LT recipients, 65.4% in patients with cirrhosis and 100% in healthy control participants. Among LT recipients, 28% of patients developed neither a humoral response nor a T-cell response following their second vaccination dose. Researchers noted while increased age (> 65 years: OR = 4.57; 95% CI, 1.48-14.05) and arterial hypertension (OR = 2.5; 95% CI, 1.1-5.68) predicted low humoral response, vaccine failure was less likely among patients dosed with calcineurin inhibitor monotherapy compared with other immunosuppressive regiments (OR = 0.36; 95% CI, 0.13-0.99).
“Cirrhotic patients had an overall serological response comparable to healthy controls. In contrast, almost half of LT recipients showed no or only a low spike-specific antibody response after the second vaccination,” Ruether and colleagues concluded. “We suggest a third or even a fourth booster vaccination in all LT recipients and cirrhotic patients with low or missing antibody titers. Further prospective studies are needed to establish an effective vaccination strategy for non-responders.”