Antibody Responses after SARS-CoV-2 Vaccination in Patients with Liver Diseases

Abstract

The novel mRNA-based vaccines against SARS-CoV-2 display encouraging safety and efficacy profiles. However, there is a paucity of data regarding their immunogenicity and safety in patients with liver diseases (PWLD), especially in those with cirrhosis. We prospectively assessed anti-SARS-CoV-2 S-spike IgG antibodies and neutralizing activity in fully vaccinated PWLD (n = 87) and controls (n = 40). Seroconversion rates were 97.4% (37/38) in cirrhotic PWLD, 87.8% (43/49) in non-cirrhotic PWLD and 100% (40/40) in controls. Adequate neutralizing activity was detected in 92.1% (35/38), 87.8% (43/49) and 100% (40/40) of cirrhotics, non-cirrhotics and controls, respectively. On multivariable analysis, immunosuppressive treatment was negatively correlated with anti-SARS-CoV-2 antibody titers (coefficient (SE): -2.716 (0.634), p < 0.001) and neutralizing activity (coefficient (SE): -24.379 (4.582), p < 0.001), while age was negatively correlated only with neutralizing activity (coefficient (SE): -0.31(0.14), p = 0.028). A total of 52 responder PWLD were reassessed approximately 3 months post-vaccination and no differences were detected in humoral responses between cirrhotic and non-cirrhotic PWLD. No significant side effects were noted post vaccination, while no symptomatic breakthrough infections were reported during a 6-month follow up. Overall, our study shows that m-RNA-based SARS-CoV-2 vaccines are safe and efficacious in PWLD. However, PWLD under immunosuppressive treatment and those of advanced age should probably be more closely monitored after vaccination.

Keywords: SARS-CoV-2; cirrhosis; immunosuppression; liver diseases; vaccination.

Figure 1

Humoral immune responses one month after the second vaccine dose in cirrhotic PWLD, non-cirrhotic PWLD and controls. (a) Anti-SARS-CoV-2 S1-protein IgG antibody titers; (b) neutralizing activity. PWLD—patients with liver disease; SARS-CoV-2—severe acute respiratory syndrome coronavirus 2; OD₄₅₀—optical density of serum samples measured at 450 nm; OD_cal—optical density of calibrator; ns—non-significant.

Figure 2

Kinetics of humoral immune responses approximately 3 months after the 2nd vaccine dose in cirrhotic PWLD and non-cirrhotic PWLD. (a) Anti-SARS-CoV-2 S1-protein IgG antibody titers; (b) neutralizing activity. PWLD—patients with liver disease; SARS-CoV-2—severe acute respiratory syndrome coronavirus 2; OD₄₅₀—optical density of serum samples measured at 450 nm; OD_cal—optical density of calibrator; ns—non-significant; * p < 0.05; ** p < 0.01; *** p < 0.001