SARS-CoV-2 vaccine alleviates disease burden and severity in liver transplant recipients even with low antibody titers
Background and Aims:. We retrospectively assessed the clinical Pfizer’s mRNA SARS-CoV-2 BNT162b2 vaccination outcomes and the serologic impact on liver transplant (LT) recipients. Patients and Methods:. One hundred and sixty-seven LT cases followed between March 1, 2020 and September 25, 2021, and w...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health/LWW
2023-02-01
|
| Series: | Hepatology Communications |
| Online Access: | http://journals.lww.com/10.1097/HC9.0000000000000025 |
| _version_ | 1811161594678214656 |
|---|---|
| author | Abed Khalaileh Ashraf Imam Alaa Jammal David Hakimian Johnny Amer Asher Shafrir Yael Milgrom Muhammad Massarwa Wadi Hazou Majd Khader Rifaat Safadi |
| author_facet | Abed Khalaileh Ashraf Imam Alaa Jammal David Hakimian Johnny Amer Asher Shafrir Yael Milgrom Muhammad Massarwa Wadi Hazou Majd Khader Rifaat Safadi |
| author_sort | Abed Khalaileh |
| collection | DOAJ |
| description | Background and Aims:. We retrospectively assessed the clinical Pfizer’s mRNA SARS-CoV-2 BNT162b2 vaccination outcomes and the serologic impact on liver transplant (LT) recipients.
Patients and Methods:. One hundred and sixty-seven LT cases followed between March 1, 2020 and September 25, 2021, and were stratified into two groups: (1) 37 LT recipients after SARS-CoV-2 infection before vaccine era and (2) 130 LT recipients vaccinated with 2 doses without earlier SARS-CoV-2 exposure. Serum SARS-CoV-2 spike immunoglobulins (anti-S) were assessed 7 days following vaccination (Liaison assay).
Results:. In addition to the 37 nonvaccinated cases (22.2% of total group) who experienced SARS-CoV-2 infection (34 symptomatic and 3 asymptomatic), another 8 vaccinated symptomatic recipients (4.8%) were infected (5 from the third and three from the fourth waves). Three of the 45 infected cases died (6.7%) before the vaccine program. Vaccinated group: of the 130 LT vaccinated recipients, 8 (6.2%) got infected postvaccination (added to the infected group) and were defined as clinical vaccine failure; 38 (29.2%) were serological vaccine failure (total failure 35.4%), and 64.6% cases were serological vaccine responders (anti-S≥19 AU/mL). Longer post-LT interval and lower consumption of immunosuppressants (steroids, FK506, and mycophenolate mofetil) correlated with favorable SARS-CoV-2 vaccine response. Mammalian target of rapamycin inhibitors improved vaccine outcomes associated with lower FK506 dosages and serum levels. Patients with anti-S levels <100 AU/mL risked losing serologic response or being infected with SARS-CoV-2. A booster dose achieved an effective serologic response in a third of failures and most responders, securing better and possibly longer protection.
Conclusion:. Pfizer’s BNT162b2 vaccine seems to lessen SARS-CoV-2 morbidity and mortality of LT recipients even with weak serological immunogenicity. Switching mycophenolate mofetil to mammalian target of rapamycin inhibitors might be effective before boosters in vaccine failure cases. A booster vaccine should be considered for nonresponders and low-responders after the second dose. |
| first_indexed | 2024-04-10T06:16:52Z |
| format | Article |
| id | doaj.art-020387f3a17a42739f439edb3b27ebdf |
| institution | Directory Open Access Journal |
| issn | 2471-254X |
| language | English |
| last_indexed | 2024-04-10T06:16:52Z |
| publishDate | 2023-02-01 |
| publisher | Wolters Kluwer Health/LWW |
| record_format | Article |
| series | Hepatology Communications |
| spelling | doaj.art-020387f3a17a42739f439edb3b27ebdf2023-03-02T06:30:44ZengWolters Kluwer Health/LWWHepatology Communications2471-254X2023-02-0172e0025e002510.1097/HC9.0000000000000025HC90000000000000025SARS-CoV-2 vaccine alleviates disease burden and severity in liver transplant recipients even with low antibody titersAbed Khalaileh0Ashraf Imam1Alaa Jammal2David Hakimian3Johnny Amer4Asher Shafrir5Yael Milgrom6Muhammad Massarwa7Wadi Hazou8Majd Khader9Rifaat Safadi10 1 Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel 1 Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel 1 Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel 1 Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel 1 Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel 1 Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel 1 Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel 1 Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel 1 Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel 1 Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel 1 Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, IsraelBackground and Aims:. We retrospectively assessed the clinical Pfizer’s mRNA SARS-CoV-2 BNT162b2 vaccination outcomes and the serologic impact on liver transplant (LT) recipients. Patients and Methods:. One hundred and sixty-seven LT cases followed between March 1, 2020 and September 25, 2021, and were stratified into two groups: (1) 37 LT recipients after SARS-CoV-2 infection before vaccine era and (2) 130 LT recipients vaccinated with 2 doses without earlier SARS-CoV-2 exposure. Serum SARS-CoV-2 spike immunoglobulins (anti-S) were assessed 7 days following vaccination (Liaison assay). Results:. In addition to the 37 nonvaccinated cases (22.2% of total group) who experienced SARS-CoV-2 infection (34 symptomatic and 3 asymptomatic), another 8 vaccinated symptomatic recipients (4.8%) were infected (5 from the third and three from the fourth waves). Three of the 45 infected cases died (6.7%) before the vaccine program. Vaccinated group: of the 130 LT vaccinated recipients, 8 (6.2%) got infected postvaccination (added to the infected group) and were defined as clinical vaccine failure; 38 (29.2%) were serological vaccine failure (total failure 35.4%), and 64.6% cases were serological vaccine responders (anti-S≥19 AU/mL). Longer post-LT interval and lower consumption of immunosuppressants (steroids, FK506, and mycophenolate mofetil) correlated with favorable SARS-CoV-2 vaccine response. Mammalian target of rapamycin inhibitors improved vaccine outcomes associated with lower FK506 dosages and serum levels. Patients with anti-S levels <100 AU/mL risked losing serologic response or being infected with SARS-CoV-2. A booster dose achieved an effective serologic response in a third of failures and most responders, securing better and possibly longer protection. Conclusion:. Pfizer’s BNT162b2 vaccine seems to lessen SARS-CoV-2 morbidity and mortality of LT recipients even with weak serological immunogenicity. Switching mycophenolate mofetil to mammalian target of rapamycin inhibitors might be effective before boosters in vaccine failure cases. A booster vaccine should be considered for nonresponders and low-responders after the second dose.http://journals.lww.com/10.1097/HC9.0000000000000025 |
| spellingShingle | Abed Khalaileh Ashraf Imam Alaa Jammal David Hakimian Johnny Amer Asher Shafrir Yael Milgrom Muhammad Massarwa Wadi Hazou Majd Khader Rifaat Safadi SARS-CoV-2 vaccine alleviates disease burden and severity in liver transplant recipients even with low antibody titers Hepatology Communications |
| title | SARS-CoV-2 vaccine alleviates disease burden and severity in liver transplant recipients even with low antibody titers |
| title_full | SARS-CoV-2 vaccine alleviates disease burden and severity in liver transplant recipients even with low antibody titers |
| title_fullStr | SARS-CoV-2 vaccine alleviates disease burden and severity in liver transplant recipients even with low antibody titers |
| title_full_unstemmed | SARS-CoV-2 vaccine alleviates disease burden and severity in liver transplant recipients even with low antibody titers |
| title_short | SARS-CoV-2 vaccine alleviates disease burden and severity in liver transplant recipients even with low antibody titers |
| title_sort | sars cov 2 vaccine alleviates disease burden and severity in liver transplant recipients even with low antibody titers |
| url | http://journals.lww.com/10.1097/HC9.0000000000000025 |
| work_keys_str_mv | AT abedkhalaileh sarscov2vaccinealleviatesdiseaseburdenandseverityinlivertransplantrecipientsevenwithlowantibodytiters AT ashrafimam sarscov2vaccinealleviatesdiseaseburdenandseverityinlivertransplantrecipientsevenwithlowantibodytiters AT alaajammal sarscov2vaccinealleviatesdiseaseburdenandseverityinlivertransplantrecipientsevenwithlowantibodytiters AT davidhakimian sarscov2vaccinealleviatesdiseaseburdenandseverityinlivertransplantrecipientsevenwithlowantibodytiters AT johnnyamer sarscov2vaccinealleviatesdiseaseburdenandseverityinlivertransplantrecipientsevenwithlowantibodytiters AT ashershafrir sarscov2vaccinealleviatesdiseaseburdenandseverityinlivertransplantrecipientsevenwithlowantibodytiters AT yaelmilgrom sarscov2vaccinealleviatesdiseaseburdenandseverityinlivertransplantrecipientsevenwithlowantibodytiters AT muhammadmassarwa sarscov2vaccinealleviatesdiseaseburdenandseverityinlivertransplantrecipientsevenwithlowantibodytiters AT wadihazou sarscov2vaccinealleviatesdiseaseburdenandseverityinlivertransplantrecipientsevenwithlowantibodytiters AT majdkhader sarscov2vaccinealleviatesdiseaseburdenandseverityinlivertransplantrecipientsevenwithlowantibodytiters AT rifaatsafadi sarscov2vaccinealleviatesdiseaseburdenandseverityinlivertransplantrecipientsevenwithlowantibodytiters |