Immune responses and clinical outcomes after COVID-19 vaccination in patients with liver disease and liver transplant recipients

Murray, S. M. et al. (2024) Immune responses and clinical outcomes after COVID-19 vaccination in patients with liver disease and liver transplant recipients. Journal of Hepatology, 80(1), pp. 109-123. (doi: 10.1016/j.jhep.2023.10.009) (PMID:37863203)

Abstract

Background & 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 <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.

• Item Type: Articles
• Additional Information: Authors: on behalf of the OCTAVE Collaborative Group, PITCH study, and the EASL supported COVID-Hep vaccine network.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Woolcock, Mr Kieran
• Authors: Murray, S. M., Pose, E., Wittner, M., Londoño, M.-C., Schaub, G., Cook, J., Dimitriadis, S., Meacham, G., Irwin, S., Lim, Z., Duengelhoef, P., Sterneck, M., Lohse, A. W., Perez, V., Trivedi, P., Bhandal, K., Mullish, B. H., Manousou, P., Provine, N. M., Avitabile, E., Carroll, M., Tipton, T., Healy, S., Burra, P., Klenerman, P., Dunachie, S., Kronsteiner, B., Maciola, A. K., Pasqual, G., Hernandez-Gea, V., Garcia-Pagan, J. C., Lampertico, P., Iavarone, M., Gines, P., Lütgehetmann, M., Schulze zur Wiesch, J., Russo, F. P., Barnes, E., Marjot, T., , , and OCTAVE Collaborative Group,
• College/School: College of Medical Veterinary and Life Sciences > School of Infection & Immunity
• Journal Name: Journal of Hepatology
• Publisher: Elsevier on behalf of European Association for the Study of the Liver
• ISSN: 0168-8278
• Published Online: 18 October 2023
• Copyright Holders: Copyright © 2023 The Author(s)
• First Published: First published in Journal of Hepatology 80(1):109-123
• Publisher Policy: Reproduced under a creative commons licence