Serological response and breakthrough infection after COVID-19 vaccination in patients with cirrhosis and post-liver transplant

被引：3

作者：

Mehta, Gautam ^{[1
,2
,3
]}

Riva, Antonio ^{[2
,4
]}

Ballester, Maria Pilar ^{[5
]}

Uson, Eva ^{[6
]}

Pujadas, Montserrat ^{[6
]}

Carvalho-Gomes, Angela ^{[7
,8
]}

Sahuco, Ivan ^{[7
,8
]}

Bono, Ariadna ^{[7
,8
]}

D'Amico, Federico ^{[9
,10
]}

Vigano, Raffaela ^{[11
]}

Diago, Elena ^{[12
,13
,14
]}

Lanseros, Beatriz Tormo ^{[12
,14
]}

Inglese, Elvira ^{[11
,15
]}

Vazquez, Dani Martinez ^{[16
]}

Sharma, Rajni ^{[2
]}

Tsou, Hio Lam Phoebe ^{[2
]}

Harris, Nicola ^{[2
]}

Broekhoven, Annelotte ^{[17
]}

Kikkert, Marjolein ^{[18
]}

Morales, Shessy P. Torres ^{[18
]}

Myeni, Sebenzile K. ^{[18
]}

Riveiro-Barciela, Mar ^{[16
]}

Palom, Adriana ^{[16
]}

Zeni, Nicola ^{[19
]}

Brocca, Alessandra ^{[19
]}

Cussigh, Annarosa ^{[20
]}

Cmet, Sara ^{[20
]}

Escudero-Garcia, Desamparados ^{[5
]}

Stocco, Matteo ^{[5
]}

Natola, Leonardo Antonio ^{[21
]}

Ieluzzi, Donatella ^{[21
]}

Paon, Veronica ^{[21
]}

Sangiovanni, Angelo ^{[22
]}

Farina, Elisa ^{[22
]}

di Benedetto, Clara ^{[22
]}

Sanchez-Torrijos, Yolanda ^{[23
]}

Lucena-Varela, Ana ^{[23
]}

Roman, Eva ^{[24
,25
]}

Sanchez, Elisabet ^{[14
,24
]}

Sanchez-Aldehuelo, Ruben ^{[26
,27
]}

Lopez-Cardona, Julia ^{[26
]}

Canas-Perez, Itzel ^{[3
]}

Eastgate, Christine ^{[3
]}

Jeyanesan, Dhaarica ^{[28
]}

Morocho, Alejandro Esquivel ^{[28
]}

Di Cola, Simone ^{[29
]}

Lapenna, Lucia ^{[29
]}

Zaccherini, Giacomo ^{[30
]}

Bongiovanni, Deborah ^{[30
]}

Zanaga, Paola ^{[31
,32
,33
]}

机构：

[1] UCL, Inst Liver & Digest Heath, London, England

[2] Fdn Liver Res, Roger Williams Inst Hepatol, London, England

[3] Royal Free London NHS Fdn Trust, London, England

[4] Kings Coll London, Fac Life Sci & Med, London, England

[5] Hosp Clin Univ Valencia, Dept Gastroenterol & Hepatol, Valencia, Spain

[6] European Fdn Study Chron Liver Failure EF CLIF, EASL CLIF Consortium & Grifols Chair, Barcelona, Spain

[7] La Fe Univ Hosp, Hepatol HBP Surg & Transplantat Hepatol & Liver T, Valencia, Spain

[8] Univ Valencia, Ciberehd, Valencia, Spain

[9] ASST Grande Osped Metropolitano Niguarda, Infect Dis Unit, Milan, Italy

[10] Univ Milan, Postgrad Sch Clin Pharmacol & Toxicol, Dept Med Biotechnol & Translat Med, Milan, Italy

[11] ASST Grande Osped Metropolitano Niguarda, Hepatol & Gastroenterol Unit, Milan, Italy

[12] Hosp Univ Puerta Hierro Majadahonda, Dept Gastroenterol & Hepatol, IDIPHIM, Madrid, Spain

[13] Hosp Univ La Paz, Cent Unit Clin Res & Clin Trials, IdiPaz, Madrid, Spain

[14] CIBERehd, Madrid, Spain

[15] Univ Pavia, Dept Brain & Behav Sci, Pavia, Italy

[16] Hosp Univ Valle Hebron, Liver Unit, Barcelona, Spain

[17] Leiden Univ, Dept Gastroenterol & Hepatol, Med Ctr, Leiden, Netherlands

[18] Leiden Univ, Dept Med Microbiol, Med Ctr, Leiden, Netherlands

[19] Univ Padua, UIMH, Dept Med DIMED, Padua, Italy

[20] Univ Udine, Azienda Sanit Univ Integrata, Hepatol & Liver Transplantat Unit, Udine, Italy

[21] Azienda Osped Univ Integrata Verona, Verona, Italy

[22] Fdn IRCCS Ca Granda Osped Maggiore Policlin, Div Gastroenterol & Hepatol, Milan, Italy

[23] Univ Seville, Hosp Univ Virgen del Rocio, Inst Biomed Sevilla, Seville, Spain

[24] Hosp Santa Creu & Sant Pau, Barcelona, Spain

[25] EUI St Pau Sch Nursing, Barcelona, Spain

[26] Hosp Univ Ramon y Cajal, Ctr Invest Biomed Red Enfermedades Hepat & Digest, Inst Ramon y Cajal Invest Sanitaria IRYCIS, Serv Gastroenterol,Inst Salud Carlos III, Madrid, Spain

[27] Univ Alcala, Madrid, Spain

[28] Kings Coll Hosp NHS Fdn Trust, Inst Liver Studies, London, England

[29] Univ Rome Sapienza, Dept Translat & Precis Med, Rome, Italy

[30] Univ Bologna, Dept Med & Surg Sci, Bologna, Italy

[31] Univ Padua, Dept Surg Oncol & Gastroenterol, Padua, Italy

[32] Azienda Osped Univ Padova, Gastroenterol Unit, Padua, Italy

[33] Azienda Osped Univ Padova, Multivisceral Transplant Unit, Padua, Italy

[34] Mid & South Essex NHS Fdn Trust, Basildon, England

[35] Marques Valdecilla Univ Hosp, Dept Gastroenterol & Hepatol, Santander, Spain

[36] Inst Invest Sanitaria Valdecilla IDIVAL, Clin & Traslat Digest Res Grp, Santander, Spain

[37] Univ Malaga, Hosp Univ Virgen de la Victoria, Serv Aparato Digest, Malaga, Spain

[38] Univ Autonoma Madrid, Hosp Univ La Paz, Liver Unit, CIBERehd, Madrid, Spain

[39] Ghent Univ Hosp, Dept Gastroenterol & Hepatol, Ghent, Belgium

[40] Univ Ghent, Liver Res Ctr Ghent, Ghent, Belgium

[41] European Reference Network ERN RARE LIVER, Hamburg, Germany

[42] Univ Barcelona, Inst Invest Biomed August Pi Sunyer IDIBAPS, Hosp Clin, Liver Unit, Barcelona, Spain

[43] Ctr Invest Biomed Red CIBEREHD, Barcelona, Spain

[44] ELPA, Brussels, Belgium

[45] Azienda Osped Univ Bologna, Unit Semeiot Liver & Alcohol Related Dis, Bologna, Italy

[46] Paris Est Univ, Henri Mondor Hosp, APHP, Dept Hepat,Liver Transplant Unit, Paris, France

[47] Univ Insubria, Infect & Trop Dis Unit, Dept Med & Surg, ASST Sette Laghim, Varese, Italy

[48] EASL, Geneva, Switzerland

[49] Univ Med Ctr Rotterdam, Erasmus MC Transplant Inst, Div HPB & Transplant Surg, Dept Surg, Rotterdam, Netherlands

[50] Univ Milano Bicocca, Infect Dis Niguarda Great Metropolitan Hosp, Milan, Italy

来源：

HEPATOLOGY COMMUNICATIONS | 2023年 / 7卷 / 11期

关键词：

D O I：

10.1097/HC9.0000000000000273

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background: Vaccine hesitancy and lack of access remain major issues in disseminating COVID-19 vaccination to liver patients globally. Factors predicting poor response to vaccination and risk of breakthrough infection are important data to target booster vaccine programs. The primary aim of the current study was to measure humoral responses to 2 doses of COVID-19 vaccine. Secondary aims included the determination of factors predicting breakthrough infection.Methods: COVID-19 vaccination and Biomarkers in cirrhosis And post-Liver Transplantation is a prospective, multicenter, observational case-control study. Participants were recruited at 4-10 weeks following first and second vaccine doses in cirrhosis [n = 325; 94% messenger RNA (mRNA) and 6% viral vaccine], autoimmune liver disease (AILD) (n = 120; 77% mRNA and 23% viral vaccine), post-liver transplant (LT) (n = 146; 96% mRNA and 3% viral vaccine), and healthy controls (n = 51; 72% mRNA, 24% viral and 4% heterologous combination). Serological end points were measured, and data regarding breakthrough SARS-CoV-2 infection were collected.Results: After adjusting by age, sex, and time of sample collection, anti-Spike IgG levels were the lowest in post-LT patients compared to cirrhosis (p < 0.0001), AILD (p < 0.0001), and control (p = 0.002). Factors predicting reduced responses included older age, Child-Turcotte-Pugh B/C, and elevated IL-6 in cirrhosis; non-mRNA vaccine in AILD; and coronary artery disease, use of mycophenolate and dysregulated B-call activating factor, and lymphotoxin-alpha levels in LT. Incident infection occurred in 6.6%, 10.6%, 7.4%, and 15.6% of cirrhosis, AILD, post-LT, and control, respectively. The only independent factor predicting infection in cirrhosis was low albumin level.Conclusions: LT patients present the lowest response to the SARS-CoV-2 vaccine. In cirrhosis, the reduced response is associated with older age, stage of liver disease and systemic inflammation, and breakthrough infection with low albumin level.

引用

页数：25

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