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

Abstract

Aims Patients with liver disease may exhibit higher infection rates and mortality rates from coronavirus disease 2019 (COVID‐19) than healthy individuals, and vaccination against severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is an effective prevention strategy. This meta‐analysis aimed to assess the effectiveness and safety of SARS‐CoV‐2 vaccines in patients with chronic liver disease (CLD) and post‐liver transplantation (LT). Methods The PubMed, Embase, and Cochrane databases were searched. A random‐effects model meta‐analysis was used to determine the seropositivity rates of SARS‐CoV‐2 antibodies, odds ratio (OR) compared with healthy controls (HC), risk ratio (RR) between the booster and standard vaccination regimen, and the rate of adverse reactions (ADR). Results In the standard vaccination regimen analysis, 17 controlled articles were included for effectiveness analysis, and six articles for ADR analysis. The pooled seropositivity rates of SARS‐CoV‐2 antibodies in patients with CLD and post‐LT were 93.3% (95% confidence interval [CI]: 89.0%–97.6%) and 69.1% (95% CI: 63.0%–75.3%), respectively. Both rates were lower than those in HC (p < 0.001). The differences remained significant after sorting by detection interval, vaccine type, antibody type, or CLD type. LT recipients showed much lower seropositivity rates of antibodies than patients with CLD (69.1% vs. 93.3%) or HC (OR: 0.055). The pooled total ADR rate of patients was 24.0% (95% CI: 16.2%–31.8%). In the booster vaccination regimen analysis, 11 prospective studies were enrolled, and the seropositivity rates of antibodies after the booster dose were increased by 27% compared with those of the standard vaccination regimen (RR: 1.27, 95% CI: 1.15–1.41, p < 0.001). Conclusion Patients with CLD and post‐LT can gain protection against COVID‐19 from standard vaccines, demonstrating a potentially weaker immunogenic response than HC. Booster vaccines can compensate for this deficiency. Therefore, patients with CLD and post‐LT should be prioritized for receiving the COVID‐19 booster vaccine.