Spike-specific humoral and cellular immune responses after COVID-19 mRNA vaccination in patients with cirrhosis: A prospective single center study

• Published in: Digestive and liver disease Vol. 55; no. 2; pp. 160 - 168
• Main Authors: Iavarone, Massimo, Tosetti, Giulia, Facchetti, Floriana, Topa, Matilde, Er, Joey Ming, Hang, Shou Kit, Licari, Debora, Lombardi, Andrea, D'Ambrosio, Roberta, Degasperi, Elisabetta, Loglio, Alessandro, Oggioni, Chiara, Perbellini, Riccardo, Caccia, Riccardo, Bandera, Alessandra, Gori, Andrea, Ceriotti, Ferruccio, Scudeller, Luigia, Bertoletti, Antonio, Lampertico, Pietro
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-02-2023; Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd
• Subjects: Antibodies; Antibodies, Viral; BNT162 Vaccine; Breakthrough Infections; Carcinoma, Hepatocellular; COVID-19 - prevention & control; COVID-19 Vaccines - adverse effects; Hepatitis B; Hepatitis C; Hepatocellular carcinoma; Humans; Immunity, Cellular; Liver Cirrhosis; Liver Neoplasms; Liver, Pancreas and Biliary Tract; Moderna mRNA-1273; Nucleocapsid-protein; Pfizer-BioNTech BNT162b2; Portal hypertension; Prospective Studies; RNA, Messenger; SARS-CoV-2; Spike-protein; Vaccination; Spike-protein; Pfizer-BioNTech BNT162b2; SARS-CoV-2; Moderna mRNA-1273; Portal hypertension; Hepatocellular carcinoma; Nucleocapsid-protein; Hepatitis C; Hepatitis B
• ISSN: 1590-8658; 1878-3562
• DOI: 10.1016/j.dld.2022.09.010

COVID-19 mRNA vaccines were approved to prevent severe forms of the disease, but their immunogenicity and safety in cirrhosis is poorly known.
In this prospective single-center study enrolling patients with cirrhosis undergoing COVID-19 vaccination (BNT162b2 and mRNA-1273), we assessed humoral and cellular responses vs healthy controls, the incidence of breakthrough infections and adverse events (AEs). Antibodies against spike- and nucleocapsid-protein (anti-S and anti-N) and Spike-specific T-cells responses were quantified at baseline, 21 days after the first and second doses and during follow-up.
182 cirrhotics (85% SARS-CoV-2-naïve) and 38 controls were enrolled. After 2 doses of vaccine, anti-S titres were significantly lower in cirrhotics vs controls [1,751 (0.4–25,000) U/mL vs 4,523 (259–25,000) U/mL, p=0.012] and in SARS-CoV-2-naïve vs previously infected cirrhotics [999 (0.4–17,329) U/mL vs 7,500 (12.5–25,000) U/mL, (p<0.001)]. T-cell responses in cirrhotics were similar to controls, although with different kinetics. In SARS-CoV-2-naïve cirrhotics, HCC, Child-Pugh B/C and BNT162b2 were independent predictors of low response. Neither unexpected nor severe AEs emerged. During follow-up, 2% turned SARS-CoV-2 positive, all asymptomatic.
Humoral response to COVID-19 vaccines appeared suboptimal in patients with cirrhosis, particularly in SARS-CoV-2-naïve decompensated cirrhotics, although cellular response appeared preserved, and low breakthrough infections rate was registered.