Thuluvath Paul J, Robarts Polly, Chauhan Mahak
Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore MD, USA; Department of Medicine, University of Maryland School of Medicine, Baltimore MD, USA.
Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore MD, USA.
J Hepatol. 2021 Dec;75(6):1434-1439. doi: 10.1016/j.jhep.2021.08.008. Epub 2021 Aug 26.
BACKGROUND & AIMS: Liver transplant (LT) recipients or other immunocompromised patients were not included in the registration trials studying the efficacy of vaccines against SARS-CoV-2. Although the clinical efficacy of COVID-19 vaccines in immunocompromised patients is unknown, many societies have recommended vaccination of this highly vulnerable patient population.
In this prospective study, we determined antibody responses to spike protein, 4 weeks after the 2 dose of mRNA vaccines or after the single dose of Johnson & Johnson vaccine, in LT recipients and those with chronic liver disease (CLD) with and without cirrhosis.
Of the 233 patients enrolled so far, 62 were LT recipients, 79 had cirrhosis (10 decompensated) and 92 had CLD without cirrhosis. Antibody titers were defined as undetectable (<0.40 U/ml), suboptimal (0.40-250 U/ml) and adequate (>250 U/ml). Of the 62 patients who had LT, antibody levels were undetectable in 11 patients and suboptimal (median titer 17.6, range 0.47-212 U/ml) in 27 patients. Among 79 patients with cirrhosis, 3 had undetectable antibody levels and 15 had suboptimal (median titer 41.3, range 0.49-221 U/L) antibody responses. Of the 92 patients without cirrhosis, 4 had undetectable antibody levels and 19 had suboptimal (median titer 95.5, range 4.9-234 U/L) antibody responses. Liver transplantation, use of 2 or more immunosuppression medications and vaccination with a single dose of the Johnson & Johnson vaccine were associated with poor immune response on multivariable analysis. No patient had any serious adverse events.
Poor antibody responses after SARS-CoV-2 vaccination were seen in 61% of LT recipients and 24% of those with CLD.
The clinical efficacy of COVID-19 vaccines in immunocompromised patients is unknown. We performed a prospective study to evaluate immune responses to COVID-19 vaccines (Moderna, Pfizer or Johnson & Johnson) in 62 liver transplant recipients, 79 patients with cirrhosis and 92 with chronic liver diseases without cirrhosis. We found that 17.8% of liver transplant recipients, 3.8% of those with cirrhosis and 4.3% of those with chronic liver diseases without cirrhosis had undetectable antibody levels. In total, 61.3% of liver transplant recipients and 24% of those with chronic liver diseases (with or without cirrhosis) had poor antibody responses (undetectable or suboptimal). Liver transplantation, use of immunosuppressive medications and vaccination with a single dose of Johnson & Johnson vaccine were associated with poor antibody responses when adjusted for other factors.
研究新冠病毒疫苗疗效的注册试验未纳入肝移植（LT）受者或其他免疫功能低下的患者。尽管新冠病毒疫苗在免疫功能低下患者中的临床疗效尚不清楚，但许多协会已建议为这一高度脆弱的患者群体接种疫苗。
在这项前瞻性研究中，我们测定了LT受者以及患有和未患有肝硬化的慢性肝病（CLD）患者在接种2剂mRNA疫苗或单剂强生疫苗4周后对刺突蛋白的抗体反应。
在迄今招募的233例患者中，62例为LT受者，79例患有肝硬化（10例失代偿期），92例患有无肝硬化的CLD。抗体滴度定义为检测不到（<0.40 U/ml）、次优（0.40 - 250 U/ml）和充足（>250 U/ml）。在62例LT患者中，11例患者抗体水平检测不到，27例患者抗体水平次优（中位滴度17.6，范围0.47 - 212 U/ml）。在79例肝硬化患者中，3例抗体水平检测不到，15例抗体反应次优（中位滴度41.3，范围0.49 - 221 U/L）。在92例无肝硬化患者中，4例抗体水平检测不到，19例抗体反应次优（中位滴度95.5，范围4.9 - 234 U/L）。多变量分析显示，肝移植、使用2种或更多种免疫抑制药物以及接种单剂强生疫苗与免疫反应不佳有关。没有患者出现任何严重不良事件。
61%的LT受者和24%的CLD患者在接种新冠病毒疫苗后抗体反应不佳。
新冠病毒疫苗在免疫功能低下患者中的临床疗效尚不清楚。我们进行了一项前瞻性研究，以评估62例肝移植受者、79例肝硬化患者和92例无肝硬化的慢性肝病患者对新冠病毒疫苗（Moderna、辉瑞或强生）的免疫反应。我们发现，17.8%的肝移植受者、3.8%的肝硬化患者和4.3%的无肝硬化慢性肝病患者抗体水平检测不到。总体而言，61.3%的肝移植受者和24%的慢性肝病患者（无论有无肝硬化）抗体反应不佳（检测不到或次优）。在对其他因素进行调整后，肝移植、使用免疫抑制药物和接种单剂强生疫苗与抗体反应不佳有关。
