COVID-19 Vaccine Perception in Liver Transplant Recipients: Patient-Reported Outcomes and Real-Life Experience from the Bergamo Center

Alessandro Loglio; Elisa Farina; Francesco Ideo; Giovanni Alfieri; Tiziana Negri; Flavia Neri; Valentina Zuccaro; Stefano Fagiuoli; Stefania Camagni; Mauro Viganò

doi:10.3390/vaccines13050455

COVID-19 Vaccine Perception in Liver Transplant Recipients: Patient-Reported Outcomes and Real-Life Experience from the Bergamo Center

Vaccines (Basel). 2025 Apr 24;13(5):455. doi: 10.3390/vaccines13050455.

Authors

Alessandro Loglio¹, Elisa Farina¹, Francesco Ideo^{1

2}, Giovanni Alfieri³, Tiziana Negri³, Flavia Neri⁴, Valentina Zuccaro^{5

6}, Stefano Fagiuoli^{1

2}, Stefania Camagni⁴, Mauro Viganò^{1

2}

Affiliations

¹ Gastroenterology, Hepatology and Transplantation Division, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy.
² Gastroenterology, Department of Medicine, University of Milano Bicocca, 20126 Milan, Italy.
³ Associazione Amici del Trapianto di Fegato ODV (Ordine dei Volontari), 24127 Bergamo, Italy.
⁴ Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy.
⁵ Department of Diagnostic, Paediatric, Clinical and Surgical Science, University of Pavia, 27100 Pavia, Italy.
⁶ Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.

Abstract

Background: Bergamo was the most severely affected Italian province at the onset of the 2020 COVID-19 pandemic. The liver transplant (LT) patient population should be among the more sensitized to the concept of health prevention. Long-term data on both perception and outcomes of SARS-CoV-2 vaccination in LT recipients since the COVID-19 vaccine became available in Italy are still lacking.

Methods: From May to October 2023, a survey on actively followed LT recipients at our institution was carried on by the local patient' advocacy (Associazione Amici del Trapianto di Fegato) to define the rate of vaccinated subjects, SARS-CoV-2 infections and self-reported COVID-19-related outcomes.

Results: Out of the consecutive 753 adult LT recipients invited to the survey, 356 responded (47.3%) [71% male, 63 years old (20-85), LT performed a mean of 9 years (1-26) before vaccination] and were included in the analysis. All patients received the first vaccine dose between December 2020 and January 2022 (81.7% Cominarty^®, 17.7% Spikevax^®, 0.3% Vaxzevria^® and 0.3% Jcovden^®). In the following years, adherence to the vaccination policy decreased progressively over time: the second, third, fourth, and fifth vaccine doses were administered to 99%, 94%, 72%, and 22% of the LT population by October, 2023. In total, 43 (12%) and 93 (26%) patients reported a COVID-19 episode before and after [13 (7-21) months] the first vaccination, respectively; none of the LT recipients reported a second COVID-19 infection after the following vaccination cycles. Forty-six (13%) reported short-term post-vaccination mild adverse events but none developed either acute or chronic rejection episodes or hospitalization for COVID-19-related symptoms. A total of 64% of LT recipients resulted positive for anti-nucleocapsid serological test in 2023.

Conclusions: COVID-19 vaccines are safe and effective in LT recipients, underlining once again the importance of vaccination in this special population at higher risk of complications from communicable infectious diseases.

Keywords: COVID-19; SARS-CoV-2; liver transplantation; safety; self-reported outcomes; vaccine.