@article{Murray_S-2023_180069,
title = {Immune responses and clinical outcomes after COVID-19 vaccination in patients with liver disease and liver transplant recipients},
author = {Murray, S. and Pose, E. and Wittner, M. and Londoño, M. and Schaub, G. and Cook, J. and Dimitriadis, S. and Meacham, G. and Irwin, S. and Lim, Z. and Duengelhoef, P. and Sterneck, M. and Lohse, A. and Perez, V. and Trivedi, P. and Bhandal, K. and Mullish, B. and Manousou, P. and Provine, N. and Avitabile, E. and Carroll, M. and Tipton, T. and Healy, S. and Burra, P. and Klenerman, P. and Dunachie, S. and Kronsteiner, B. and Maciola, A. and Pasqual, G. and Hernandez-Gea, V. and Garcia-Pagan, J. and Lampertico, P. and Iavarone, M. and Ginès, P. and Lütgehetmann, M. and Schulze zur Wiesch, J. and Russo, F. and Barnes, E. and Marjot, T.},
month = {oct},
year = {2023},
abstract = {Background &amp; Aims: Comparative assessments of immunogenicity following different COVID-19 vaccines in patients with distinct liver diseases are lacking. SARS-CoV-2-specific T-cell and antibody responses were evaluated longitudinally after one to three vaccine doses, with long-term follow-up for COVID-19-related clinical outcomes. Methods: A total of 849 participants (355 with cirrhosis, 74 with autoimmune hepatitis [AIH], 36 with vascular liver disease [VLD], 257 liver transplant recipients [LTRs] and 127 healthy controls [HCs]) were recruited from four countries. Standardised immune assays were performed pre and post three vaccine doses (V1-3). Results: In the total cohort, there were incremental increases in antibody titres after each vaccine dose (p &lt;0.0001). Factors associated with reduced antibody responses were age and LT, whereas heterologous vaccination, prior COVID-19 and mRNA platforms were associated with greater responses. Although antibody titres decreased between post-V2 and pre-V3 (p = 0.012), patients with AIH, VLD, and cirrhosis had equivalent antibody responses to HCs post-V3. LTRs had lower and more heterogenous antibody titres than other groups, including post-V3 where 9% had no detectable antibodies; this was heavily influenced by intensity of immunosuppression. Vaccination increased T-cell IFNγ responses in all groups except LTRs. Patients with liver disease had lower functional antibody responses against nine Omicron subvariants and reduced T-cell responses to Omicron BA.1-specific peptides compared to wild-type. 122 cases of breakthrough COVID-19 were reported of which 5/122 (4%) were severe. Of the severe cases, 4/5 (80%) occurred in LTRs and 2/5 (40%) had no serological response post-V2. Conclusion: After three COVID-19 vaccines, patients with liver disease generally develop robust antibody and T-cell responses to vaccination and have mild COVID-19. However, LTRs have sustained no/low antibody titres and appear most vulnerable to severe disease.},
pages = {109-123},
volume = {80},
issue = {1},
journal = {Journal of Hepatology},
publisher = {Elsevier},
url = {http://dx.doi.org/10.1016/j.jhep.2023.10.009},
}
