Zignani Nunzio, Costantino Andrea, Sagasta Michele, Dibenedetto Clara, Perbellini Riccardo, Uceda Renteria Sara, Lampertico Pietro, Donato Maria Francesca
Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy.
Gastroenterology and Endoscopy Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Vaccines (Basel). 2025 Mar 26;13(4):352. doi: 10.3390/vaccines13040352.
The COVID-19 pandemic highlighted the vulnerability of immunocompromised individuals, including liver transplant recipients (LTRs), who often exhibit reduced vaccine immunogenicity. While initial vaccine doses and subsequent boosters improved immune response, LTRs were prioritized for vaccination. Studies have shown increased antibody response after each booster dose. Vaccine hesitancy, defined as delayed or refused vaccination despite availability, poses a public health challenge, often fueled by misinformation. This study aimed to evaluate anti-spike antibody responses in vaccinated LTRs after two initial doses and at least one booster, also assessing adherence to subsequent doses.
We conducted a retrospective observational study at a transplant center in Milan, Italy, between January 2021 and December 2023. LTRs who had received four or more doses of mRNA vaccines (Pfizer or Moderna) were included. Anti-spike antibody levels were measured 60-80 days after each dose. Data on vaccination status were collected in January 2024. Statistical analysis was performed to compare antibody responses and identify predictive factors.
LTRs showed a significant increase in anti-spike antibody responses after the first booster compared to the second dose with a trend versus a further increase following the fourth dose in a subgroup of the patients receiving two booster doses. However, adherence to booster doses decreased over time. In LTRs, predictors of a weaker response after the second dose were chronic kidney disease and metabolic etiology at transplant.
The study highlighted that in LTRs, multiple doses of the COVID-19 vaccine led to a continuous increase in anti-spike antibody responses. The progressive decline in adherence of LTRs "to further booster doses" should be related to the fact that after the spread of vaccination programs worldwide, COVID-19 is still a current infection, but it is much less severe than before.
2019冠状病毒病（COVID-19）大流行凸显了免疫功能低下个体的脆弱性，包括肝移植受者（LTRs），他们往往表现出疫苗免疫原性降低。虽然初始疫苗剂量和后续加强针改善了免疫反应，但LTRs被优先安排接种疫苗。研究表明，每次加强针接种后抗体反应都会增强。疫苗犹豫是指尽管有疫苗供应，但仍延迟或拒绝接种疫苗，这构成了一项公共卫生挑战，往往是由错误信息助长的。本研究旨在评估接种两剂初始疫苗和至少一剂加强针后接种疫苗的LTRs中的抗刺突抗体反应，同时评估对后续剂量的依从性。
我们于2021年1月至2023年12月在意大利米兰的一个移植中心进行了一项回顾性观察研究。纳入接受了四剂或更多剂mRNA疫苗（辉瑞或莫德纳）的LTRs。在每次接种后60-80天测量抗刺突抗体水平。2024年1月收集疫苗接种状态数据。进行统计分析以比较抗体反应并确定预测因素。
与第二剂相比，LTRs在第一次加强针接种后抗刺突抗体反应显著增加，在接受两剂加强针的患者亚组中，与第四剂接种后进一步增加呈趋势关系。然而，随着时间的推移，对加强针剂量的依从性下降。在LTRs中，第二剂接种后反应较弱的预测因素是慢性肾病和移植时的代谢病因。
该研究强调，在LTRs中，多剂COVID-19疫苗导致抗刺突抗体反应持续增加。LTRs对进一步加强针剂量的依从性逐渐下降，这应该与以下事实有关：在全球疫苗接种计划推广后，COVID-19仍然是一种当前的感染，但严重程度比以前轻得多。
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