Full COVID-19 vaccination decreased infection, death post-liver transplant
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Post-liver transplant recipients who were fully vaccinated against COVID-19 saw a decrease in COVID-19 infection or death, according to a presentation at The Liver Meeting Digital Experience.
“Full vaccination with two doses of a COVID-19 mRNA vaccine is associated with a 64% decrease in COVID-19, a 58% reduction in symptomatic COVID-19 and 87% reduction in death among liver transplant recipients,” Binu V. John, MD, MPH, affiliate associate professor at the University of Miami Miller School of Medicine and chief of hepatology at the Bruce W. Carter VA Medical Center, said during the presentation.
From Dec. 15, 2020, to April 30, 2021, John, also the chief of hepatology with the Miami VA Health System, and colleagues used ICD codes to identify 1,936 patients from a group of patients with cirrhosis who underwent liver transplantation between 2008 and 2020. Of these patients, 799 were fully vaccinated.
Investigators considered patients fully vaccinated 7 days after receiving the second dose of either the Pfizer BNT162b2 mRNA or Moderna 1273 mRNA vaccines, or 28 days post-Janssen Ad.26.COV2.S vaccine. A positive COVID-19 PCR test or death served as the outcomes. Investigators propensity matched 753 vaccinated and 753 control patients with similar sex, age, race, location, smoking status, comorbidities (chronic obstructive pulmonary disease, hypertension and kidney transplantation) and immunosuppressive therapies (calcineurin inhibitor and anti-metabolite therapy). To control for immortal bias, vaccination date of each vaccinated patient was assigned to the matched control. A Cox regression model was used to estimate hazard ratios of COVID-19 infection or COVID-19 related death associated with vaccination. John and colleagues censored event-free patients at the end of the study period or after the controls got fully vaccinated.
John and colleagues found patients who were fully vaccinated tended to be older, male, white, have COPD and hypertension, post-kidney transplant, be on a calcineurin inhibitor and anti-metabolite and less likely to be a smoker. There were two vaccinated patients and 15 patients in the control group who developed COVID-19 infection after the date of full vaccination.
According to John, there were no deaths in the vaccinated group; two COVID-19 related deaths were noted in the control group.
Full vaccination against COVID-19 correlated with a 75% reduction in COVID-19 infection or death (adjusted HR = 0.25; 95% CI, 0.07-0.87; P = .03), according to multivariable analysis results.
“Reduction of SARs-CoV-2 infection and death appear to be greater than suggested by antibody response,” John said. “This raises the possible role of T cell-mediated response to vaccination. Similar observations have been noted with influenza vaccine in liver transplant recipients despite low antibody titers, vaccination associated with reduction in hospitalization and death.”
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John B, et al. Abstract: 16. Presented at: The Liver Meeting Digital Experience; Nov. 12-15, 2021 (virtual meeting).
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