Humoral Response to SARS-Cov-2 Vaccination in Liver Transplant Recipients–A Single-Center Experience

Abstract

Vaccination against SARS-CoV-2 infection is currently approved and shows favorable outcomes, but little known about antibody responses in solid organ transplant recipients, since these patients are known to have an impaired immune response upon vaccination and have not been included in admission studies. We therefore analyzed immunogenicity in 43 liver transplant (LT) recipients in a median of 15 days (IQR, 12–24) after receiving two doses of the mRNA-based SARS-CoV-2 vaccine BNT162b2 following the standard protocol, and compared these results to a control group consisting of 20 healthcare workers (HCWs). Thirty-four of the 43 (79%) LT recipients developed antibodies, compared to 20 out of 20 (100%) in the control group (p = 0.047). The median SARS-CoV-2 IgG titer was significantly lower in the LT recipients compared to the control group (216 vs. >2080 BAU/mL, p = 0.0001). Age and sex distribution was similar in the LT patients that developed antibodies after vaccination compared to those who did not. Interestingly, the patients who received mycophenolate mofetil exhibited a reduced vaccination response compared to the other LT patients (5 of 11 (45.5%) vs. 29 of 32 (90.6%), p = 0.004). In conclusion, our data reveal lower immunogenicity of SARS-CoV-2 vaccine BNT162b2 in LT patients compared to the control group, but still show superior results compared to other solid organ transplant recipients reported so far.

Immunological and clinical efficacy of COVID-19 vaccines in immunocompromised populations: a systematic review

“…Forty-seven studies described immunogenicity across various solid organ transplant populations ( n = 5974), mostly in kidney transplant recipients ( n = 3534, 59.2%) ( Table S5 ) [ 18 , [20] , [21] , [22] , [23] , [24] , [25] , [26] , 29 , 34 , 40 , [56] , [57] , [58] ], [ 62 , 63 , 65 , 66 , 69 , 72 , 73 , 75 , 77 , 79 , 81 , 120 , 126 ], [ [136] , [137] , [138] , [139] , [140] , [141] , [142] , [143] , [144] , [145] , [146] , [147] , [148] , [149] , [150] , [151] , [152] , [153] , [154] , [155] , [156] , [157] , [158] , [159] , [160] ]. Twenty-four of those studies included a control group representing overall 1399 participants [ 21 , 34 , 57 , 63 , 66 , 69 , 72 , 73 , 75 , 79 , ...…”

“…Solid organ transplant-specific treatments (calcineurin inhibitors, antimetabolites, corticosteroids) were often associated with a higher non-response rate or lower antibody titres [ 20 , 21 , 24 , 40 , 56 , 62 , 65 , 69 , 72 , 75 , 81 , 136 , [138] , [139] , [140] , [141] , [142] , 144 , 145 , 148 , [154] , [155] , [156] , [157] , 159 , 160 ] ( Table S5 ). Older age and lower estimated glomerular filtration rate were repeatedly associated with a non-responder status [ 21 , 24 , 79 , 120 , 138 , 142 , 144 , 155 ].…”

Humoral and Cellular Vaccination Responses against SARS-CoV-2 in Hematopoietic Stem Cell Transplant Recipients

“…Whereas several reports addressed the immunogenicity of the COVID-19 vaccines in solid organ transplant recipients, especially after kidney transplantation, data after hematopoietic stem cell transplantation are still scarce. It has been published that humoral [ 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ] as well as cellular vaccination responses [ 12 , 14 , 16 ] were diminished after solid organ transplantation. A recent preprint publication described that in patients after heart and lung transplantation, baseline levels of activated PD-1+ HLA-DR+ CXCR5- CD4+ T cells (also known as T peripheral helper [T PH ] cells) and CD4+ T cells strongly predicted the ability to mount an antibody response against SARS-CoV-2 [ 17 ].…”

Predictors of Humoral Response to mRNA COVID19 Vaccines in Kidney Transplant Recipients: A Longitudinal Study—The COViNEPH Project

“…In contrast, kidney transplant recipients (KTR) demonstrated a markedly impaired seroconversion rate of 40-60% after two doses of mRNA vaccines [7][8][9]. Liver, heart, and lung transplant recipients exhibited a reduced response to mRNA-based vaccines as well [10][11][12]. In a recently published study by Stumpf et al, KTR not only demonstrated a low humoral response following two doses of mRNA vaccines, but also displayed substantial impairment of the cellular response [13].…”