COVID-19 Resource Center

COVID-19 Resource Center

Disclosures: The authors report no relevant financial disclosures.
September 13, 2021
1 min read

Age, arterial hypertension predicts COVID-19 vaccine response in LT patients

Disclosures: The authors report no relevant financial disclosures.
You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact

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.”

Among liver transplant recipients who received the COVID-19 vaccine: 28%  of patients developed neither a humoral response nor a T-cell response following their second vaccination dose.

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.”