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Toniutto P, Cussigh A, Cmet S, Fabris M, Curcio F, Bitetto D, Fornasiere E, Fumolo E, Falleti E. Mycophenolate Interruption Restores Anti-SARS-CoV-2 Vaccine Immunogenicity in Unresponsive Liver Transplant Recipients. Vaccines (Basel) 2023; 11:1165. [PMID: 37514981 PMCID: PMC10383127 DOI: 10.3390/vaccines11071165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/19/2023] [Accepted: 06/24/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND & AIMS The fourth dose of anti-SARS-CoV-2 vaccine slightly improved the humoral response among previously seronegative liver transplant (LT) recipients. Mycophenolate (MMF) treatment worsens the vaccination response. This study aimed to evaluate whether temporary MMF interruption might improve the immunogenicity of the fourth anti-SARS-CoV-2 BNT16b2 vaccine dose in nonresponsive LT recipients. METHODS LT recipients negative for anti-spike glycoprotein-specific immunoglobulin G receptor-binding domain (s-RBD) antibodies after the third vaccine dose were enrolled. Anti-SARS-CoV-2 spike-specific T-cell responses were measured before and 2 months following the fourth vaccine dose, and anti-SARS-CoV-2 s-RBD antibodies also 6 months thereafter. MMF was suspended two weeks before and after vaccination. RESULTS Five LT recipients were enrolled. After a mean of 78 days after vaccination, all patients tested positive for anti-SARS-CoV-2 s-RBD antibodies. The mean antibody titer was 8944 UI/mL. The positive antibody response was maintained during a mean of 193 days of follow-up. Three patients developed a positive T-cell response. Two patients (one positive for T-cell response) developed a self-limited SARS-CoV-2 infection. CONCLUSIONS Suspending MMF prior to the fourth dose of the anti-SARS-CoV-2 mRNA vaccine seems feasible and safe. This procedure could restore vaccine-induced immunogenicity in a large portion of previously nonresponsive LT recipients.
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Affiliation(s)
- Pierluigi Toniutto
- Hepatology and Liver Transplantation Unit, Department of Specialized Medicine, Udine University Hospital, 33100 Udine, Italy
| | - Annarosa Cussigh
- Clinical Pathology, Udine University Hospital, 33100 Udine, Italy
| | - Sara Cmet
- Clinical Pathology, Udine University Hospital, 33100 Udine, Italy
| | - Martina Fabris
- Clinical Pathology, Udine University Hospital, 33100 Udine, Italy
| | - Francesco Curcio
- Clinical Pathology, Udine University Hospital, 33100 Udine, Italy
| | - Davide Bitetto
- Hepatology and Liver Transplantation Unit, Department of Specialized Medicine, Udine University Hospital, 33100 Udine, Italy
| | - Ezio Fornasiere
- Hepatology and Liver Transplantation Unit, Department of Specialized Medicine, Udine University Hospital, 33100 Udine, Italy
| | - Elisa Fumolo
- Hepatology and Liver Transplantation Unit, Department of Specialized Medicine, Udine University Hospital, 33100 Udine, Italy
| | - Edmondo Falleti
- Hepatology and Liver Transplantation Unit, Department of Specialized Medicine, Udine University Hospital, 33100 Udine, Italy
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So BN, Reddy KR. Liver Transplantation for the Nonhepatologist. Med Clin North Am 2023; 107:605-621. [PMID: 37001956 DOI: 10.1016/j.mcna.2023.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Liver transplantation (LT) is a life-saving and evidence-based intervention for patients with acute liver failure and chronic end-stage liver disease. Significant progress has been made in advancing pre-LT management, transplant techniques, post-LT long-term care, and immunosuppression regimes. However, as rates of DC continue to increase, causes of liver disease and indications for LT continue to be investigated to ensure equity and further improve liver allocation models, waitlist outcomes, and post-LT outcomes for all patient populations.
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Affiliation(s)
- Bethany Nahri So
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - K Rajender Reddy
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, University of Pennsylvania, 2 Dulles, 3400 Spruce Street, HUP, Philadelphia, PA 19104, USA.
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3
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Dumortier J, Dharancy S, Bréard T, Saliba F. Influenza and SARS-CoV-2 vaccinations adherence after liver transplantation during the second year of the COVID-19 pandemic (results of a patients' survey). JOURNAL OF LIVER TRANSPLANTATION 2022; 8:100111. [PMID: 38013901 PMCID: PMC9262648 DOI: 10.1016/j.liver.2022.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Jérôme Dumortier
- Fédération des Spécialités Digestives, Hospices civils de Lyon, Hôpital Edouard Herriot, Lyon
| | | | - Thomas Bréard
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France
| | - Faouzi Saliba
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France
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4
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Dumortier J, Dharancy S, Bréard T, Sérée O, Saliba F. Influenza vaccination adherence after liver transplantation: A collateral benefit of the COVID-19 pandemic (results of a patients' survey). Clin Res Hepatol Gastroenterol 2022; 46:101815. [PMID: 34583065 PMCID: PMC8645288 DOI: 10.1016/j.clinre.2021.101815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 02/04/2023]
Affiliation(s)
- Jérôme Dumortier
- Fédération des Spécialités Digestives, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, France,Address for correspondence: Pavillon L, Hôpital Edouard Herriot, 69437 Lyon Cedex 03, France
| | | | - Thomas Bréard
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France
| | - Olivier Sérée
- Réseau Régional de Cancérologie OncoBasseNormandie, Caen, France
| | - Faouzi Saliba
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France
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5
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An Essential Guide for Managing Post-Liver Transplant Patients: What Primary Care Physicians Should Know. Am J Med 2022; 135:157-166. [PMID: 34508700 DOI: 10.1016/j.amjmed.2021.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 12/16/2022]
Abstract
With long-term survival after liver transplantation becoming the rule, care for medical problems arising over time in liver-transplanted patients gained increasing importance. The most common causes of death occurring more than 1 year after liver transplantation are unrelated to liver diseases and facilitated by immunosuppressive treatments; examples are malignancies, renal failure, and cardiovascular, metabolic, and infectious diseases. Recipients receive life-long follow-up care at transplant centers, however, the increasing number of liver-transplanted patients is saturating the health care supply that transplant centers have to offer. Primary care physicians are increasingly exposed to liver-transplanted patients, even in the early periods after transplant, and an understanding of the most common risks and complications faced by these patients would enhance their care. This article reviews the long-term care of liver transplant recipients, emphasizing the key internal medicine-related issues that should be known by primary care physicians. A specific section is devoted to implementing strategies to involve these physicians in the long-term follow-up of liver-transplanted patients in close collaboration with transplant hepatologists.
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Spadaccini M, Canziani L, Aghemo A, Lleo A, Maselli R, Anderloni A, Carrara S, Fugazza A, Pellegatta G, Galtieri PA, Hassan C, Greenwald D, Pochapin M, Wallace M, Sharma P, Roesch T, Bhandari P, Emura F, Raju GS, Repici A. What gastroenterologists should know about SARS-CoV 2 vaccine: World Endoscopy Organization perspective. United European Gastroenterol J 2021; 9:787-796. [PMID: 34102015 PMCID: PMC8242672 DOI: 10.1002/ueg2.12103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/01/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The novel Coronavirus (SARS-CoV-2) has caused almost 2 million deaths worldwide. Both Food and Drug Administration and European Medicines Agency have recently approved the first COVID-19 vaccines, and a few more are going to be approved soon. METHODS Several different approaches have been used to stimulate the immune system in mounting a humoral response. As more traditional approaches are under investigation (inactivated virus vaccines, protein subunit vaccines, recombinant virus vaccines), more recent and innovative strategies have been tried (non-replicating viral vector vaccines, RNA based vaccines, DNA based vaccines). RESULTS Since vaccinations campaigns started in December 2020 in both the US and Europe, gastroenterologists will be one of the main sources of information regarding SARS-CoV 2 vaccination for patients in their practice, including vulnerable patients such as those with Inflammatory Bowel Disease (IBD), patients with chronic liver disease, and GI cancer patients. CONCLUSIONS Thus, we must ourselves be well educated and updated in order to provide unambiguous counseling to these categories of vulnerable patients. In this commentary, we aim to provide a comprehensive review of both approved COVID-19 vaccines and the ones still under development, and explore potential risks, benefits and prioritization of vaccination.
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Affiliation(s)
- Marco Spadaccini
- Department of Biomedical SciencesHumanitas UniversityRozzanoItaly
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Lorenzo Canziani
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
- Department of Internal MedicineHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Alessio Aghemo
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
- Department of GastroenterologyDivision of Internal Medicine and HepatologyHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Ana Lleo
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
- Department of GastroenterologyDivision of Internal Medicine and HepatologyHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Roberta Maselli
- Department of Biomedical SciencesHumanitas UniversityRozzanoItaly
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Andrea Anderloni
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Silvia Carrara
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Alessandro Fugazza
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Gaia Pellegatta
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Piera Alessia Galtieri
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
| | - Cesare Hassan
- Digestive Endoscopy UnitNuovo Regina MargheritaRomeItaly
| | - David Greenwald
- Division of GastroenterologyIcahn School of Medicine at Mount SinaiMount Sinai HospitalNew YorkNew YorkUSA
| | - Mark Pochapin
- Division of Gastroenterology and HepatologyNYU Langone HealthNew YorkNew YorkUSA
| | - Michael Wallace
- Division of Gastroenterology and HepatologyMayo ClinicJacksonvilleFloridaUSA
| | - Prateek Sharma
- Digestive Endoscopy UnitKansas City VA Medical CenterKansas CityMissouriUSA
| | - Thomas Roesch
- Division of Gastroenterology & HepatologyUniversity Medical Center Hamburg ‐ EppendorfHamburgGermany
| | - Pradeep Bhandari
- Division of Gastroenterology and HepatologyQueen Alexandra HospitalPortsmouthUK
| | - Fabian Emura
- Division of GastroenterologyUniversidad de La SabanaChíaColombia
| | - Gottumukkala S Raju
- Department of Gastroenterology, Hepatology, and NutritionThe University of TexasMD Anderson Cancer CenterHoustonTexasUSA
| | - Alessandro Repici
- Department of Biomedical SciencesHumanitas UniversityRozzanoItaly
- Department of GastroenterologyEndoscopy UnitHumanitas Clinical and Research Center IRCCSRozzanoItaly
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Gracia-Ramos AE, Jaquez-Quintana JO, Contreras-Omaña R, Auron M. Liver dysfunction and SARS-CoV-2 infection. World J Gastroenterol 2021; 27:3951-3970. [PMID: 34326607 PMCID: PMC8311530 DOI: 10.3748/wjg.v27.i26.3951] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/09/2021] [Accepted: 06/16/2021] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 infection is the cause of coronavirus disease 2019 (COVID-19), which predominantly affects the respiratory system; it also causes systemic and multi-organic disease. Liver damage is among the main extrapulmonary manifestations. COVID-19-associated liver injury is defined as any liver damage occurring during the disease course and treatment of COVID-19 in patients with or without pre-existing liver disease, and occurs in approximately one in five patients. Abnormal liver test results have been associated with a more severe course of COVID-19 and other complications, including death. Mechanisms linking COVID-19 to liver injury are diverse. Particular consideration should be made for patients with pre-existing liver disease, such as metabolic dysfunction-associated fatty liver disease, chronic liver disease due to viral or autoimmune disease, liver transplant carriers, or cirrhosis, given the risk for more severe outcomes. This manuscript summarizes the current lines of evidence on COVID-19-associated liver injury regarding pathophysiology, clinical significance, and management in both patients with or without pre-existing liver disease, to facilitate clinicians' access to updated information and patient care. Finally, we mention the ideas and recommendations to be considered for future research.
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Affiliation(s)
- Abraham Edgar Gracia-Ramos
- Department of Internal Medicine, General Hospital, National Medical Center "La Raza", Instituto Mexicano del Seguro Social, Mexico City 02990, Mexico
| | - Joel Omar Jaquez-Quintana
- Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital "Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64460, Mexico
| | - Raúl Contreras-Omaña
- Centro de Estudio e Investigación en Enfermedades Hepáticas y Toxicológicas (CEIHET), Pachuca 42184, Mexico
| | - Moises Auron
- Departments of Hospital Medicine and Pediatric Hospital Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
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8
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Italian association for the study of the liver position statement on SARS-CoV2 vaccination. Dig Liver Dis 2021; 53:677-681. [PMID: 33941488 PMCID: PMC8086184 DOI: 10.1016/j.dld.2021.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 02/06/2023]
Abstract
The vaccination campaign against Sars-CoV-2 commenced in Italy at the end of December 2020. The first ones to receive the immunization against the virus were the health workers and the residents of nursing homes, following which the vaccine would be available for the entire population, beginning with the most vulnerable individuals. SARS-CoV2 vaccines have been demonstrated to be safe for the general population, although no data for patients with liver diseases or those having undergone liver transplantation are available so far. The present position statement AISF is an attempt to suggest, based on the published data on the impact of Sars-Cov-2 infection in patients with chronic liver disease, a possible priority for vaccination for this category of patients.
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9
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Harrington CR, Yang GY, Levitsky J. Advances in Rejection Management: Prevention and Treatment. Clin Liver Dis 2021; 25:53-72. [PMID: 33978583 DOI: 10.1016/j.cld.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Extended survival of liver transplant recipients has brought rejection management to the forefront of liver transplant research. This article discusses T-cell-mediated rejection, antibody-mediated rejection, and chronic rejection. We focus on the prevention and then discuss treatment options. Future directions of rejection management include biomarkers of rejection, which may allow for monitoring of patients who are considered high risk for rejection and detection of rejection before there is any clinical evidence to improve graft and patient survival. With improved graft life and survival of liver transplant recipients, the new frontier of rejection management focuses on immunosuppression minimization, withdrawal, and personalization.
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Affiliation(s)
- Claire R Harrington
- Department of Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 2330, Chicago, IL 60611, USA
| | - Guang-Yu Yang
- Department of Pathology, Northwestern University Feinberg School of Medicine, 251 E Huron St. Chicago, IL 60611, USA
| | - Josh Levitsky
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 1400, Chicago, IL 60611, USA; Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 1900, Chicago, IL 60611, USA.
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