Efficacy, Safety and Immunogenicity of Anti-SARS-CoV-2 Vaccines in Patients with Cirrhosis: A Narrative Review

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19), has led to a pandemic with more than 6.5 million deaths worldwide. Patients with liver cirrhosis (PWLC) are regarded as prone to severe COVID-19. Vaccination against SARS-CoV-2 has been proven to be the most effective measure against COVID-19 and a variety of different vaccines have been approved for use; namely mRNA and vector-based, inactivated, whole virion, and protein subunit vaccines. Unfortunately, only a small number of PWLC were included in phase I–III vaccine trials, raising concerns regarding their efficacy and safety in this population. The authors, in this review, present available data regarding safety and efficacy of anti-SARS-CoV-2 vaccination in PWLC and discuss post-vaccination antibody responses. Overall, all vaccines seem to be extremely safe, with only a few and insignificant adverse events, and efficient, leading to lower rates of hospitalization and COVID-19-related mortality. T- and B-cell responses, on the other hand, remain an enigma, especially in patients with decompensated disease, since these patients show lower titers of anti-SARS-CoV-2 antibodies in some studies, with a more rapid waning. However, this finding is not consistent, and its clinical impact is still undetermined.

Safety and Immunogenicity After Primary and Booster Inactivated SARS-Cov-2 Vaccination in Patients with Autoimmune Liver Diseases

“…Although several previous studies have shown weakened antibody responses to COVID-19 vaccines in patients with cirrhosis, 35 – 38 the finding is still controversial 39 Because some studies found no differences in the humoral responses of cirrhotic and noncirrhotic patients. 40 , 41 In this study, the antibody responses in the two groups were similar (data not shown), which may be explained by the small sample size or different vaccine types.…”

COVID-19 in Individuals with Chronic Liver Diseases

“…Patients with liver cirrhosis are characterized by immune dysfunction, leading amongst others in defective vaccineresponse [28][29][30] and a high susceptibility in viral and bacterial infections. This, in conjunction with the fact that, most drugs used against SARS-CoV-2 are hepatotoxic and are therefore contra-indicated in severe liver insufficiency, has made liver cirrhosis to be presumed as a significant risk factor for severe COVID-19.…”

Inactivated SARS-CoV-2 booster vaccine enhanced immune responses in patients with chronic liver diseases

“…The overall benefits of vaccination outweigh the risks of these rare side effects ( Bril et al., 2021 ; Chow et al., 2022 ; Efe et al., 2022 ; Lleo et al., 2022 ; Palla et al., 2022 ). Several studies focusing on the immunogenicity of SARS-CoV-2 vaccination in CLD patients reported that the CLD patients developed a lower protective immune response after two doses of inactivated, mRNA or vector-based SARS-CoV-2 vaccines, compared to healthy individuals ( Ai et al., 2022 ; Bakasis et al., 2022 ; Duengelhoef et al., 2022 ; Ruether et al., 2022 ; Thuluvath et al., 2021 ; Toutoudaki et al., 2023 ; Xiang et al., 2021 ). After two shots of the inactivated vaccine, the seropositivity rates of neutralizing antibodies were higher in CLD patients with Child-Pugh A classification than those with B and C ( Wang et al., 2022 ).…”