Antibody Responses after SARS-CoV-2 Vaccination in Patients with Liver Diseases

Abstract

The novel mRNA-based vaccines against SARS-CoV-2 display encouraging safety and efficacy profiles. However, there is a paucity of data regarding their immunogenicity and safety in patients with liver diseases (PWLD), especially in those with cirrhosis. We prospectively assessed anti-SARS-CoV-2 S-spike IgG antibodies and neutralizing activity in fully vaccinated PWLD (n = 87) and controls (n = 40). Seroconversion rates were 97.4% (37/38) in cirrhotic PWLD, 87.8% (43/49) in non-cirrhotic PWLD and 100% (40/40) in controls. Adequate neutralizing activity was detected in 92.1% (35/38), 87.8% (43/49) and 100% (40/40) of cirrhotics, non-cirrhotics and controls, respectively. On multivariable analysis, immunosuppressive treatment was negatively correlated with anti-SARS-CoV-2 antibody titers (coefficient (SE): −2.716 (0.634), p < 0.001) and neutralizing activity (coefficient (SE): −24.379 (4.582), p < 0.001), while age was negatively correlated only with neutralizing activity (coefficient (SE): −0.31(0.14), p = 0.028). A total of 52 responder PWLD were reassessed approximately 3 months post-vaccination and no differences were detected in humoral responses between cirrhotic and non-cirrhotic PWLD. No significant side effects were noted post vaccination, while no symptomatic breakthrough infections were reported during a 6-month follow up. Overall, our study shows that m-RNA-based SARS-CoV-2 vaccines are safe and efficacious in PWLD. However, PWLD under immunosuppressive treatment and those of advanced age should probably be more closely monitored after vaccination.

Antibody Response and Safety of ChAdOx1-nCOV (Covishield) in Patients with Cirrhosis: A Cross-Sectional, Observational Study

“…Most of the published data on seroconversion rates in cirrhosis following COVID-19 vaccination are with mRNA vaccines (BNT162b2; BioNTech SE/Pfizer or mRNA-1273; Moderna Biotech) or whole-virion-inactivated vaccines (CoronaVac, BBIBP-CorV, or WIBP-CorV) and seroconversion rates following ChAdOx1-nCOV vaccine are relatively unexplored [ 24 – 30 ]. The seroconversion rate of 92.1% observed in our cohort of patients with cirrhosis is similar to the impressive seroconversion rate of 96–100% reported by various studies using two doses of mRNA vaccines in cirrhosis [ 24 – 28 ]. However, the seroconversion rate of 66.1–78.9% with whole-virion-inactivated vaccines (CoronaVac, BBIBP-CorV, or WIBP-CorV) reported in two multicentric studies from China appear to be substantially lower than what was observed by us with ChAdOx1-nCOV or has been previously reported with mRNA vaccines [ 29 , 30 ].…”

“…Further, Thuluvath et al reported suboptimal antibody responses in 19% patients with optimal antibody levels in 77.2% of 79 patients with cirrhosis [ 24 ]. On the contrary, a study from Greece reported adequate neutralizing activity in 92.1% of the 38 patients with cirrhosis following two doses of mRNA vaccines [ 28 ]. In our study, undetectable and low antibody responses were seen in 7 (7.9%) and 6 (6.8%) patients, respectively.…”

Impact of COVID-19 on the liver and on the care of patients with chronic liver disease, hepatobiliary cancer, and liver transplantation: An updated EASL position paper

“…Vaccine immunogenicity Patients with CLD have been shown to have anti-SARS-CoV-2 S-spike IgG seroconversion rates of >85% following two vaccine doses [281]. However several studies have suggested that patients with cirrhosis may have a more rapid decline in antibody titers over time compared to healthy controls [281,282]. In contrast, LT recipients remain at high-risk for suboptimal humoral responses to vaccination.…”

Impaired SARS-CoV-2-specific T-cell reactivity in patients with cirrhosis following mRNA COVID-19 vaccination

“…The serological findings are coherent with those reported by Thuluvath et al [ 10 ] to support diminished humoral responses after COVID-19 vaccination in cirrhotic patients. However, this difference in antibody responses was less pronounced after the second vaccine dose, which may account for the lack of significance noted in some studies [ 11 , 18 ].…”