B0530 - COVID-19 Infection Post Liver Transplantation: A Closer Look at Vaccination Efficacy and Breakthrough Infection

Hamidreza Moein, MD, Jonathan Dvorak, MD, Alex Bramlage, MD, Philippe J. Zamor, MD
Atrium Health Wake Forest Baptist Medical Center, Charlotte, NC

Introduction: There are conflicting reports about coronavirus disease 2019 (COVID-19) infection rate and severity in solid organ recipients. These patients have low immune response after vaccination and therefore susceptible to breakthrough infection (BTI). Studies on efficacy of COVID-19 vaccination in liver transplant (LT) recipients are limited. We aimed to investigate vaccination rate, BTI, mortality rate, and risk factors in COVID-19 infection post LT.

Methods: In a retrospective chart review study, 98 post LT patients were randomly selected since Dec. 2020. BTI was defined as COVID-19 infection ≥14 days after full vaccination (2 doses of mRNA vaccines or 1 dose of viral vector). Data is reported as mean ± SEM. T- test and chi square tests were applied for analyzing the data.

Results: Fifty patients without COVID-19 infection and 48 patients with COVID-19 infection were analyzed. Mean age (58.9 ±1.1 vs. 60.5 ±1.4), gender (66% vs. 77% female), and race (82% vs. 85.4% Caucasian) were not significantly different among two groups. 81.2% of non-infected patients were fully vaccinated as compared to 31.2% of infected patients (p< 0.0001). 50% vs. 10.6% of patients received booster dose, respectively (P< 0.0001). The majority received BNT162b2 mRNA vaccine in both groups (58.5% vs. 56.2%; p >0.05). Presence of chronic kidney disease (CKD), obesity, Type 2 diabetes (T2DM), and hypertension (HTN) were not significantly different among two groups.

Among 54 fully vaccinated patients, BTI occurred in 27.7% and only 3.7% died. On the other hand, 82% of non-vaccinated patients became infected and 23% died (p=0.004; OR= 0.128). Age, gender, race, obesity, HTN, and T2DM did not have any correlation with BTI. CKD was significantly higher in those with BTI compared to vaccinated patients without BTI (80% vs. 48.7%; p=0.03). Tacrolimus monotherapy was more frequent among vaccinated patients who did not have BTI (43.5% vs. 13.3%; p=0.03). Those who had booster shots had significantly lower rate of BTI (16.6% vs. 41.6%; p=0.04; OR=0.28).

Discussion: Our study highlights the efficacy of COVID-19 vaccination and boosters in reducing rate of COVID-19 infection and BTI post LT. There was no correlation between demographic variables, choice of immunosuppression, HTN, CKD, T2DM, and obesity with COVID-19 infection. LT recipients with CKD were at higher risk of BTI. Our data suggests that tacrolimus monotherapy was protective against BTI in vaccinated patients but not in unvaccinated patients.




Disclosures:


Hamidreza Moein, MD, Jonathan Dvorak, MD, Alex Bramlage, MD, Philippe J. Zamor, MD. B0530 - COVID-19 Infection Post Liver Transplantation: A Closer Look at Vaccination Efficacy and Breakthrough Infection, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.