Spike-specific humoral and cellular immune responses after COVID-19 mRNA vaccination in patients with cirrhosis: A prospective single center study

Background and Aims: COVID-19 mRNA vaccines were approved to prevent severe forms of the disease, but their immunogenicity and safety in cirrhosis is poorly known.Method: In this prospective single-center study enrolling patients with cirrhosis undergoing COVID-19 vaccination (BNT162b2 and mRNA-1273), we assessed humoral and cellular responses vs healthy con-trols, the incidence of breakthrough infections and adverse events (AEs). Antibodies against spike-and nucleocapsid-protein (anti-S and anti-N) and Spike-specific T-cells responses were quantified at baseline, 21 days after the first and second doses and during follow-up.Results: 182 cirrhotics (85% SARS-CoV-2-naive) and 38 controls were enrolled. After 2 doses of vaccine, anti-S titres were significantly lower in cirrhotics vs controls [1,751 (0.4-25,0 0 0) U/mL vs 4,523 (259- 25,0 0 0) U/mL, p = 0.012] and in SARS-CoV-2-naive vs previously infected cirrhotics [999 (0.4-17,329) U/mL vs 7,50 0 (12.5-25,0 0 0) U/mL, (p < 0.0 01)]. T-cell responses in cirrhotics were similar to controls, although with different kinetics. In SARS-CoV-2-naive cirrhotics, HCC, Child-Pugh B/C and BNT162b2 were inde-pendent predictors of low response. Neither unexpected nor severe AEs emerged. During follow-up, 2% turned SARS-CoV-2 positive, all asymptomatic.Conclusion: Humoral response to COVID-19 vaccines appeared suboptimal in patients with cirrhosis, par-ticularly in SARS-CoV-2-naive decompensated cirrhotics, although cellular response appeared preserved, and low breakthrough infections rate was registered.(c) 2022 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.