Abstract
As COVID-19 remains an issue in transplantation medicine, a successful vaccination can prevent infections and life-threatening courses. The probability of poor immune response in liver transplant recipients gained attention and insecurity among those patients, leading us to investigate the humoral immune response alongside the influence of underlying diseases and immunosuppressive regimen on seroconversion rates. We included 118 patients undergoing anti-spike-protein-IgG testing at least 21 days after completed SARS-CoV-2 vaccination. Ninety-seven patients also underwent anti-spike-protein-IgA testing. The influence of baseline demographics, immunosuppressive regimen and underlying disease on seroconversion was analyzed, and 92 of 118 patients (78.0%) developed anti-spike-protein-IgG antibodies. Patients with a history of alcoholic liver disease before transplantation showed significantly lower seroconversion rates (p = 0.006). Immunosuppression also significantly influenced antibody development (p < 0.001). Patients run on a mycophenolate mofetil (MMF)-based regimen were more likely not to develop antibodies compared to patients run on a non-MMF regimen (p < 0.001). All patients weaned off immunosuppression were seropositive. The seroconversion rate of 78.0% in our cohort of liver transplant recipients is promising. The identification of alcohol-induced cirrhosis as underlying disease and MMF for immunosuppression as risk factors for seronegativity may serve to identify vaccination non-responder after liver transplantation.
Highlights
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic influences social life and daily health care work, but especially transplantation medicine all over the world
All patients currently not treated with any immunosuppressive medication developed anti-spikeprotein-IgG-antibodies; 73.1% of all seronegative patients were run on a mycophenolate mofetil (MMF)-based regimen, whereas 22.8% of the seropositive patients were treated with MMF
Long-lasting effects of ethanol-metabolite toxicity to the liver, and e.g., the bone marrow and consecutively the immune system may serve as an explanation. These findings may have been influenced by the applied immunosuppressive regimen, the applied regimen for alcohol-induced liver disease (ALD) patients is significantly less strict compared to liver transplant (LT) recipients with an autoimmune disease as LTindication
Summary
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic influences social life and daily health care work, but especially transplantation medicine all over the world. First results reporting a poor humoral response rose insecurity among those patients and their practitioners and led to questions of early booster vaccinations and change of vaccination substrate. It remains unclear how the humoral immune response as well as specific T-cell immunogenicity affect patients’ actual protection from infection in the first place or from a severe course of disease, respectively. Immunosuppressive therapy, may advance the risk of SARS-CoV-2 infections and the severity of the course of disease. It might influence seroconversion and protection following completed vaccination. The objective of the study was to determine the seroconversion rate after complete vaccination and to identify risk factors for non-response
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