COVID‐19 pandemic dramatically impacted transplantation landscape. Scientific societies recommend against the use of donors with active SARS‐CoV‐2 infection. Italian Transplant Authority recommended to test recipients/donors for SARS‐CoV‐2‐RNA immediately before liver transplant (LT) and, starting from November 2020, grafts from deceased donors with active SARS‐CoV‐2 infection were allowed to be considered for urgent‐need transplant candidates with active/resolved COVID‐19. We present the results of the first 10 LTs with active COVID‐19 donors within an Italian multicenter series. Only two recipients had a positive molecular test at LT and one of them remained positive up to 21 days post‐LT. None of the other eight recipients was found to be SARS‐CoV‐2 positive during follow‐up. IgG against SARS‐CoV‐2 at LT were positive in 80% (8/10) of recipients, and 71% (5/7) showed neutralizing antibodies, expression of protective immunity related to recent COVID‐19. In addition, testing for SARS‐CoV‐2 RNA on donors’ liver biopsy at transplantation was negative in 100% (9/9), suggesting a very low risk of transmission with LT. Immunosuppression regimen remained unchanged, according to standard protocol. Despite the small number of cases, these data suggest that transplanting livers from donors with active COVID‐19 in informed candidates with SARS‐CoV‐2 immunity, might contribute to safely increase the donor pool.

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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.

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