Polamraju Vinathi, Vachharajani Neeta, Gage Brian F, Crippin Jeffrey S, Chapman William C
Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States.
Section of Transplant Surgery, Washington University School of Medicine, St. Louis, MO, United States.
Front Transplant. 2025 Jan 9;3:1515964. doi: 10.3389/frtra.2024.1515964. eCollection 2024.
COVID-19 disease burden has been mitigated by vaccination; however, concerns persist regarding weakened immune responses in liver transplant (LT) recipients. This study investigates COVID-19 outcomes in LT recipients based on vaccination status.
This single-center retrospective study identified LT recipients with PCR-confirmed COVID-19 infection from 03/01/2020 to 07/31/2023. Logistic regression analyses were conducted, adjusting for age, race, co-morbidities, number of immunosuppressive agents, and infection date.
Of 1,787 registered LT recipients, 361 had confirmed COVID-19 infection. Of those, 136 were unvaccinated and 225 were vaccinated. 13% had 1 vaccine dose, 31% had 2 vaccine doses, and 56% had 3 vaccine doses prior to infection. Logistic regression found higher mortality ( = 0.001) and hospitalization ( = 0.016) rates for older recipients, while those with 3 or more vaccine doses had lower mortality ( = 0.039) and hospitalization ( = 0.008) rates. Chronic kidney disease (CKD) increased risk of hospitalization ( < 0.001). Adjusting for the date when the Omicron variant became locally predominant, the protective effect from 3 or more vaccine doses declined to an OR (95% CI) of 0.58 (0.15-2.23), = 0.39.
Three or more COVID-19 vaccine doses could decrease mortality for LT recipients, particularly older recipients and those with CKD. These individuals may benefit from vaccination and other interventions.
接种疫苗减轻了新冠病毒疾病负担；然而，肝移植（LT）受者免疫反应减弱的问题依然存在。本研究基于疫苗接种状况调查肝移植受者的新冠病毒感染结果。
这项单中心回顾性研究纳入了2020年3月1日至2023年7月31日期间经聚合酶链反应确诊感染新冠病毒的肝移植受者。进行了逻辑回归分析，并对年龄、种族、合并症、免疫抑制剂数量和感染日期进行了调整。
在1787名登记的肝移植受者中，361人确诊感染新冠病毒。其中，136人未接种疫苗，225人接种了疫苗。13%的人在感染前接种了1剂疫苗，31%的人接种了2剂疫苗，56%的人接种了3剂疫苗。逻辑回归发现，年龄较大的受者死亡率（P = 0.001）和住院率（P = 0.016）较高，而接种3剂或更多剂疫苗的受者死亡率（P = 0.039）和住院率（P = 0.008）较低。慢性肾病（CKD）增加了住院风险（P < 0.001）。在对奥密克戎变异株在当地成为主要流行株的日期进行调整后，接种3剂或更多剂疫苗的保护作用降至比值比（95%置信区间）为0.58（0.15 - 2.23），P = 0.39。
接种3剂或更多剂新冠病毒疫苗可降低肝移植受者的死亡率，尤其是老年受者和慢性肾病患者。这些个体可能从疫苗接种和其他干预措施中获益。
