Infectious Disease

Age, fibrosis, immunosuppression lead to a lower COVID vaccination response

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Hakimian D.OA-2854. Presented at the International Liver Congress; 23-26 June 2021 (virtual meeting.

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Safadi does not report any relevant financial relationships.

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A study from Israel in which vaccination against COVID reached most of the population over the age of 16 showed that elderly patients, patients after a transplant, and those with advanced liver disease had a lower immune response to the Pfizer COVID-19 vaccine.

“We had the chance to have vaccinated nearly 96% of the adult population aged 16 and over so far, and only a week ago did we start vaccinating young people between the ages of 12 and 16.” Rifaat Safadi, MD, Director of the Liver Institute at Hadassah-Hebrew University Hospital in Israel said during a press conference. “I was wondering if this affects our liver patients.”

Liver transplant, less response

This research arose from Safadi’s analysis of liver transplant patients. He explained that 41 post-LT patients had contracted COVID-19 at his facility over the course of the pandemic, but only five had received the vaccination, so he wanted to understand the vaccination response in LT patients.

“Unfortunately we have 41 liver transplant patients infected with COVID in my center and we have lost two patients. Fortunately with the vaccination and the extremely significant results we have had globally, we have had no registered transplant patients with COVID-19 in the past 3 months, ”said Safadi. “Was that a result of their vaccination or the result of the population vaccination? That was the question. “

Looking at this cohort, Safadi showed 90 post-LT patients who had received the vaccine. Of these, 58.9% had an antiserum IgG level of 19 AU / ml or more, while 35.6% had a level of less than 19 AU / ml. In addition, 5.6% contracted COVID-19 after vaccination – one after the first vaccination and four after a full vaccination. The failure rate was 41.1%.

There was a correlation between time to vaccine from transplant with responders averaging 57.3 months from transplant to vaccine and failure of only 38.4 months (P = 0.017).

“So the 40% of failures actually look like a consequence of immunosuppression. However, this very nice result of disease regression in our transplant patients is more related to vaccination of the general population, ”said Safadi. “Those who were infected after vaccination had easier disease progression and no death,” suggesting a protective factor in the vaccine.

“I kept looking to see if the severity of liver disease in patients without a transplant – often fatty liver – affected the response to the vaccine,” he said.

Fibrosis affects response

Safadi and colleagues examined serum IgG levels and fibrosis in a cohort of vaccinated HMO workers. Of the 719 tested more than 7 days after their second dose of vaccine, 98.5% were considered responders. FIB-4 data were available for 501 of these responders and 10 of the 11 failures.

Of the failures, two patients with previous kidney transplants were on traditional medication, two patients had rheumatoid arthritis who were taking steroids and another immunosuppressant, two had lymphoma and were immunocompromised, one had multiple sclerosis and were receiving biological therapy, three had metabolic syndrome, one was on hemodialysis.

“I am now starting to buff my transplant patients who have not developed a serological response with a third shot,” added Safadi.

Of the responders with FIB-4 numbers, 70.5% had an FIB-4 score of less than 1.3; 26.8% were between 1.3 and 2.67; and 2.7% had an FIB-4 greater than 2.67.

Safadi showed that a lower immune response to the vaccine correlated with age, with those with an IgG response between 19 and 100 AU / ml having a mean age of 61 years, while those with a response greater than 400 AU / ml had a mean age Had an average age of 46.3 years (P <0.0001).

There was a similar correlation with the FIB-4 score and titers. Of those with an FIB-4 score of less than 1.3, 68% had an IgG greater than 200 AU / ml, while those with an FIB-4 greater than 2, only 44.2%, had an IgG in this Range (P = 0.002).

Safadi and colleagues measured serum IgG levels in a small group of patients (n = 140) diagnosed with NAFLD and determined 200 AU / ml as the cutoff between “good” and “excellent” responses. Only two patients fell into the failure category of less than 12 AU / ml.

Safadi reported that 72.7% had an excellent response while 26.1% had a good response. Those in the good response group were 61.5 ± 10.4 years older than the excellent response group with a mean age of 53.7 ± 13.3 years (P <0.0001).

The mean serum IgG values ​​in the excellent group were 358 ± 10.6 AU / ml, while the good group had a mean value of 117.4 ± 51.4 AU / ml.

While both groups had similar BMI and gender distribution, Safadi found that the groups had differences in their NAFLD activity score (NAS) and NASH Clinical Research Network (CRN) fibrosis score. Excellent responders scored 3.6 ± 1.9 on the NAS compared to 2.9 ± 1.2 for the good responders (P = .045). The researchers attributed this mainly to significant changes in steatosis of 1.6 ± 0.9 vs. 1.2 ± 0.7 (P = 0.02).

Advanced fibrosis correlated with weaker vaccination responses, with a fibrosis score of 1.7 ± 1.1 vs. 2.2 ± 1.5 and advanced fibrosis (F3-F4) in 21.8% of the excellent responders vs. 39.6% of the good responder (P = 0.05). Similarly, those diagnosed with NAFLD by Fibroscan (Echosens; n = 60) had a lower fibrosis kPa score of 8.8 in the excellent responders group versus 13.7 in the good responders group ( P = 0.02).

“The bottom line is that the most fibrosis says the less effectiveness,” said Safadi. “All of them show that the more fibrosis, the less the response.”

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International Liver Congress

International Liver Congress

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