key: cord-0758352-7lmf7yfm
authors: Giannini, Edoardo G.; Marenco, Simona
title: High acceptance rate of COVID-19 vaccination in liver transplant recipients
date: 2021-05-28
journal: J Hepatol
DOI: 10.1016/j.jhep.2021.05.009
sha: eb189fce98be445dd33a508d1b4f57bf45d62b9a
doc_id: 758352
cord_uid: 7lmf7yfm

nan

We read with great interest the article by Cornberg et al., recently published in the Journal of Hepatology, reporting the European Association for the Study of the Liver (EASL) position on the use of COronaVIrus Disease 19 (COVID-19) vaccines in patients affected by chronic liver diseases, and in particular in liver transplant recipients [1] . Indeed, despite evidence suggesting that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is not associated with an increased risk of death in patients who received a liver transplant, these patients more frequently required ICU admission and invasive-ventilation as compared to matched controls, and therefore do represent a subset of patients that can be considered especially frail, and at high-risk of severe complications of COVID-19 [2] . Actually, the EASL position paper suggests that the benefit and potential risks of vaccination against COVID-19 should be weighed individually, and that patients with additional risk factors for severe complications, such as advanced age and comorbidities, should be prioritised [1, 3] . Furthermore, the registration studies of the various vaccines against COVID-19 approved by EMA and FDA did not include patients who had received solid organ transplantation or immune-suppression, and therefore both efficacy and safety of the available COVID-19 vaccines have not been described in liver transplant recipients, nor a particular type of vaccine can be suggested on sound basis for these patients [4] [5] [6] . Lastly, there is recent evidence that immunogenicity of vaccine against COVID-19 is lower in liver transplant recipients as compared to healthy controls, and that age, lower glomerular filtration rate, and enhanced immune-suppression are predictors of poor response to vaccination [7] .

Taking all these considerations into account we wondered how the proposal of vaccination against COVID-19 could be received by liver transplant recipients, given the evidence recently Therefore, we have demonstrated that the acceptance rate for COVID-19 vaccination among liver transplant recipients is extremely high, at least 96.6%, and that patients reporting a firm opposition to vaccination represent only a minority of potential vaccine recipients (1.9%).

Acceptance rate to vaccination was higher than expected in the general population, despite potential concerns regarding the lack of safety results available in large series of transplanted patients, and initial evidence of reduced efficacy of vaccination in this population [7] . Currently, vaccination of household members and caregivers of these patients is underway, and among these subjects immediate prioritisation is being given to those who take care of transplanted patients who could not receive COVID-19 vaccination because they had recently received a graft.

We feel that these positive results strongly emphasise how adequate counselling may enhance adherence to COVID-19 vaccination and adherence to the recommendations provided by EASL and by national scientific societies [1, 9, 10, 11] , and how a structured program may support rapid and complete COVID-19 vaccination for liver transplant recipients so as to protect this frail category of patients.

J o u r n a l P r e -p r o o f

EASL position paper on the use of COVID-19 vaccines in patients with chronic liver diseases, hepatobiliary cancer and liver transplant recipients

Determining risk factors for mortality in liver transplant patients with COVID-19

Age and comorbidity are central to the risk of death from COVID-19 in liver transplant recipients

Safety and efficacy of the BNT162b2 mRNA covid-19 vaccine

Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Low immunogenicity to SARS-CoV-2 vaccination among liver transplant recipients

A global survey of potential acceptance of a COVID-19 vaccine

Italian association for the study of the liver position statement on SARS-CoV2 vaccination. Dig Liver Dis

S1-Leitlinie zur Versorgung von Lebertransplantierten während der COVID-19-Pandemie -AWMF-Register Nr