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. 2023 Mar 17;7(4):e0100.
doi: 10.1097/HC9.0000000000000100. eCollection 2023 Apr 1.

Humoral and T-cell-mediated immunity to SARS-CoV-2 vaccination in patients with liver disease and transplant recipients

Alexandra N Willauer  1 , Susan D Rouster  2 , Heidi L Meeds  2 , Carrie L Jennings  2 , Enass A Abdel-Hameed  2 , Diane E Daria  2 , Elizabeth P Stambrook  2 , Mohamed Tarek M Shata  2 , Kenneth E Sherman  2
Affiliations

Humoral and T-cell-mediated immunity to SARS-CoV-2 vaccination in patients with liver disease and transplant recipients

Alexandra N Willauer et al. Hepatol Commun. .

Abstract

Background: SARS-CoV-2 vaccination induces a varied immune response among persons with chronic liver disease (CLD) and solid organ transplant recipients (SOTRs). We aimed to evaluate the humoral and T-cell-mediated immune responses to SARS-CoV-2 vaccination in these groups.

Methods: Blood samples were collected following the completion of a standard SARS-CoV-2 vaccination (2 doses of either BNT162b2 or mRNA-12732), and a subset of patients had a blood sample collected after a single mRNA booster vaccine. Three separate methods were utilized to determine immune responses, including an anti-spike protein antibody titer, neutralizing antibody capacity, and T-cell-mediated immunity.

Results: The cohort included 24 patients with chronic liver disease, 27 SOTRs, and 9 controls. Patients with chronic liver disease had similar immune responses to the wild-type SARS-CoV-2 compared with controls following a standard vaccine regimen and single booster vaccine. SOTRs had significantly lower anti-S1 protein antibodies (p < 0.001), neutralizing capacity (p < 0.001), and T-cell-mediated immunity response (p = 0.021) to the wild-type SARS-CoV-2 compared with controls following a standard vaccine regimen. Following a single booster vaccine, immune responses across groups were not significantly different but numerically lower in SOTRs. The neutralization capacity of the B.1.1.529 Omicron variant was not significantly different between groups after a standard vaccine regimen (p = 0.87) and was significantly lower in the SOTR group when compared with controls after a single booster vaccine (p = 0.048).

Conclusion: The immunogenicity of the SARS-CoV-2 vaccine is complex and multifactorial. Ongoing and longitudinal evaluation of SARS-CoV-2 humoral and cellular responses is valuable and necessary to allow frequent re-evaluation of these patient populations.

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Conflict of interest statement

Kenneth Sherman received grants from AbbVie, Gilead, Intercept, and Abbott. The remaining authors have no conflicts to report.

Figures

FIGURE 1
FIGURE 1
Evaluation of anti-S1 antibody response to wild-type SARS-CoV-2 after completion of a standard vaccine regimen (A and C) and following a booster vaccine (B and D) in each group. The boxplots represent the median and interquartile range with whiskers showing the minimum and maximum values. Dotted horizontal lines indicate the cutoff values for positive and negative responses. The respective proportions are provided as bar graphs. Abbreviations: CLD, chronic liver disease; HC, healthy controls; SOTR, solid organ transplant recipients; WHO BAU, World Health Organization binding antibody units. *p < 0.05.
FIGURE 2
FIGURE 2
Evaluation of neutralization capacity of wild-type SARS-CoV-2 after completion of a standard vaccine regimen (A and C) and following a booster vaccine (B and D) in each group. The boxplots represent the median and interquartile range with whiskers showing the minimum and maximum values. Dotted horizontal lines indicate the cutoff values for positive and negative responses. The respective proportions are provided as bar graphs. Abbreviations: CLD, chronic liver disease; HC, healthy control; SOTR, solid organ transplant recipient; IS, immunosuppressed; WT, wild-type. *p < 0.05.
FIGURE 3
FIGURE 3
Evaluation of neutralization capacity of the B.1.1.529 Omicron variant of SARS-CoV-2 after completion of a standard vaccine regimen (A and C) and following a booster vaccine (B and D) in each group. The boxplots represent the median and interquartile range with whiskers showing the minimum and maximum values. Dotted horizontal lines indicate the cutoff values for positive and negative responses. The respective proportions are provided as bar graphs. Abbreviations: CLD, chronic liver disease; HC, healthy controls; SOTR, solid organ transplant recipients. *p < 0.05.
FIGURE 4
FIGURE 4
Evaluation of T-cell–mediated immune response with ELISPOT to wild-type SARS-CoV-2 after completion of a standard vaccine regimen in each group. The boxplots represent the median and interquartile range with whiskers showing the minimum and maximum values. Dotted horizontal lines indicate the cutoff values for positive and negative responses. The respective proportions are provided as bar graphs. Abbreviations: CLD, chronic liver disease; HC, healthy controls; SOTR, solid organ transplant recipients; SFU, spot forming units. *p < 0.05.
FIGURE 5
FIGURE 5
Evaluation of seropositivity for anti-S1 antibody, neutralizing capacity, and T-cell–mediated ELISPOT response to wild-type SARS-CoV-2 after completion of a standard vaccine regimen in each group with overlap shown in the Venn diagram. Abbreviations: HC, healthy controls; CLD, chronic liver disease; N, number; SOTR, solid organ transplant recipients.
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