Clinical Outcomes of SARS-CoV-2 Breakthrough Infections in Liver Transplant Recipients during the Omicron Wave

• Published in: Viruses 2023-01, Vol.15 (2), p.297
• Main Authors: Herting, Anna, Jahnke-Triankowski, Jacqueline, Harberts, Aenne, Schaub, Golda M, Lütgehetmann, Marc, Ruether, Darius F, Fischer, Lutz, Addo, Marylyn M, Lohse, Ansgar W, Schulze Zur Wiesch, Julian, Sterneck, Martina
• Format: Article
• Language: English
• Subjects: Antibodies; Antigens; Breakthrough Infections; Clinical outcomes; Comorbidity; Coronaviruses; COVID-19; COVID-19 vaccines; Diabetes; Disease Progression; Dyspnea; Female; Hospitalization; Humans; Hypertension; Immune response; Immune response (cell-mediated); Infections; Liver; liver transplant recipients; Liver transplantation; Liver Transplantation - adverse effects; Liver transplants; Mortality; Patients; post-acute COVID-19 syndrome; Questionnaires; Respiration; Risk factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Statistical analysis; Transplantation; Vaccination; VOC Omicron; γ-Interferon
• ISSN: 1999-4915; 1999-4915
• DOI: 10.3390/v15020297

At the start of the pandemic, liver transplant recipients (LTR) were at high risk of developing severe COVID-19. Here, the outcomes of breakthrough infections in fully vaccinated LTR ( = 98) during the Omicron wave were assessed. In most patients, a mild disease course was observed, but 11 LTR (11.2%) required hospitalization for COVID-19-related complications. All patients survived. The LTR requiring hospitalization were older (67 years vs. 54 years; < 0.001), had a higher Charlson comorbidity index (9 vs. 5; < 0.001), and a lower anti-S RBD titer (Roche Elecsys) prior to infection (508.3 AU/mL vs. 2044 AU/mL; = 0.03). Long-lasting symptoms for ≥4 weeks were reported by 37.5% of LTR (30/80). Risk factors in LTR included female sex ( = 0.01; Odds Ratio (OR) = 4.92 (95% confidence interval (CI) (1.5-16.5)) and dyspnea ( = 0.009; OR = 7.2 (95% CI (1.6-31.6)) during infection. Post-infection high anti-S RBD antibody levels were observed in LTR, and healthy controls (HC), while the cellular immune response, assessed by interferon-gamma release assay (EUROIMMUN), was significantly lower in LTR compared with HC ( < 0.001). In summary, in fully vaccinated LTR, SARS-CoV-2 breakthrough infections during the Omicron wave led to mild disease courses in the majority of patients and further boosted the humoral and cellular hybrid anti-SARS-CoV-2-directed immune response. While all patients survived, older and multimorbid LTR with low baseline antibody titers after vaccination still had a substantial risk for a disease course requiring hospitalization due to COVID-19-related complications.