Immunogenicity of COVID‐19 vaccines in chronic liver disease patients and liver transplant recipients: A systematic review and meta‐analysis

Abstract

Background and aims Chronic liver disease (CLD) patients and liver transplant (LT) recipients have an increased risk of morbidity and mortality from coronavirus disease 2019 (COVID‐19). The immunogenicity of COVID‐19 vaccines in CLD patients and LT recipients is poorly understood. The present study aimed to evaluate the immunogenicity of COVID‐19 vaccines in CLD patients and LT recipients. Methods We searched electronic databases for eligible studies. Two reviewers independently conducted the literature search, extracted the data and assessed the risk of bias of included studies. The rates of detectable immune response were pooled from single‐arm studies. For comparative studies, we compared the rates of detectable immune response between patients and healthy controls. The meta‐analysis was conducted using the Stata software with a random‐effects model. Results In total, 19 observational studies involving 4191 participants met the inclusion criteria. The pooled rates of detectable humoral immune response after two doses of COVID‐19 vaccination in CLD patients and LT recipients were 95% (95% confidence interval [CI] = 88%–99%) and 66% (95% CI = 57%–74%) respectively. After two doses of vaccination, the humoral immune response rate was similar in CLD patients and healthy controls (risk ratio [RR] = 0.96; 95% CI = 0.90–1.02; p = .14). In contrast, LT recipients had a lower humoral immune response rate after two doses of vaccination than healthy controls (RR = 0.68; 95% CI = 0.59–0.77; p < .01). Our meta‐analysis demonstrated that COVID‐19 vaccination induced strong humoral immune responses in CLD patients but poor humoral immune responses in LT recipients.

Meta‐analysis of the immunogenicity of standard and booster SARS‐CoV‐2 vaccination in patients with chronic liver disease and post‐liver transplantation

“…14,15,[52][53][54] This meta-analysis included 17 controlled studies for effectiveness analysis and six studies for safety analysis. It was found that SARS-CoV-2 vaccines are safe and well-tolerated in patients with CLD and post-LT, while exhibiting lower pooled seropositivity rates of antibodies to vaccination, especially post-LT patients, compared with that of the healthy population; these results are consistent with those of Luo et al 55 When compared with the patients with CLD, the pooled seropositivity rates of antibodies to SARS-CoV-2 were lower in LT recipients. Moreover, this meta-analysis found that the antibody-positive rate after the booster dose increased by 27% compared with that of the standard vaccination regimen.…”

SARS-CoV-2 and the liver: clinical and immunological features in chronic liver disease

“…A recent meta-analysis demonstrated that seroconversion rates seem to be similar in patients with CLD compared with healthy individuals except for LTR 103. However, the antibody responses seem to be generally weaker.…”

COVID-19 in patients with liver disease and liver transplant: clinical implications, prevention, and management

“…6,44 A systematic review and meta-analysis of 19 studies including 1700 LT recipients, 1624 patients with CLD, and more than 800 healthy controls compared pooled rates of detectable humoral immune response to SARS-CoV-2 vaccination and found no difference between patients with CLD and healthy controls, or between cirrhotic and non-cirrhotic patients. 45 The study found that immune response depended on vaccine type, with two doses of mRNA vaccine yielding positive humoral immune response in 99% of patients with CLD, compared to 91% in those who received inactivated vaccines. 45 In studies evaluating spike-specific T-cell response to vaccination, on the other hand, patients with CLD had a significantly lower response than healthy controls, but a significantly greater response than LT recipients.…”

“…45 The study found that immune response depended on vaccine type, with two doses of mRNA vaccine yielding positive humoral immune response in 99% of patients with CLD, compared to 91% in those who received inactivated vaccines. 45 In studies evaluating spike-specific T-cell response to vaccination, on the other hand, patients with CLD had a significantly lower response than healthy controls, but a significantly greater response than LT recipients. 7 Therefore, it has been posited that despite comparable antibody seroconversion rates, ineffective T-cell response may result in decreased protection from SARS-CoV-2 in patients with CLD and LT compared to healthy controls.…”