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EASL expert position statement: Can recipients of chronic liver disease, hepatobiliary malignancies and liver transplantation be vaccinated against the new crown vaccine?

 Last Update: 2021-07-30
 Source: Internet
 Author: User

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Since 2019, the new crown epidemic has ravaged the world
.

According to an assessment by the World Health Organization (WHO), as of January 2021, nearly 100 million people worldwide have been infected with the new coronavirus

Infection immunity

However, the effectiveness, duration of immunity, and long-term safety of these vaccines in patients with CLD such as liver cirrhosis, hepatobiliary tumors, and liver transplantation are still unknown
.

The following summarizes the relevant data on the safety, immunogenicity and effectiveness of vaccination in CLD patients, and explores the impact of these cognitions on the new crown vaccine in CLD patients

The effectiveness and safety of the vaccine in patients with CLD (including hepatobiliary malignancies)

CLD patients are high-risk groups of infectious diseases, and the size of individual infection risk is related to factors such as the cause of CLD, comorbidities, concomitant medications, and the stage of the disease
.

At present, there are data on the immune effect and safety of hepatitis A, hepatitis B, seasonal influenza and pneumococcal vaccines in CLD patients, but the data on the response of patients with hepatobiliary malignancies to the vaccine is not sufficient
.

The effectiveness of the vaccine in CLD patients

At present, there is no relevant data on the tolerability, immunogenicity and safety of the new crown vaccine in patients with CLD (including hepatobiliary malignancies)
.

Safety and effectiveness of vaccines in solid organ transplantation population

People who receive solid organ transplantation (SOT) often have a chronic disease basis and need to take immunosuppressants.
The body's immune function is reduced, which affects the body's immune response to the vaccine, and the risk of infection is higher, and the condition after infection is more serious
.

Vaccination is an important measure to prevent infection and its adverse consequences.

prevention

The safety of live attenuated vaccines in SOT population is uncertain, so it should generally be avoided after organ transplantation
.

Although a meta-analysis shows that certain vaccines are relatively safe and effective for use in children and adult SOT patients, in any case, for patients after organ transplantation, the benefits and risks should be fully weighed before considering the application of live attenuated vaccines, and Special attention should be paid to avoid application during the peak period of immunosuppression

child

Within 3-6 months after transplantation, due to the strong immunosuppression of the body, the immune response to the vaccine is expected to be weak, so it is not recommended to vaccinate at this time
.

As time goes by, the body's immune memory function against vaccines weakens, so it is necessary to replant relevant vaccines in time based on the serological follow-up results
.

According to previous research results, standard dose vaccination will not increase the risk of transplant rejection

Recommendations for the application of the new crown vaccine in patients with CLD (including hepatobiliary malignancies)

More and more experience shows that preventing inflammation and infection is necessary to improve the prognosis of CLD patients
.

Particular attention should be paid to patients with hepatobiliary malignancies, because on the one hand, they often have CLD or liver cirrhosis, and on the other hand, they may delay tumor treatment after new coronary infection
.

Therefore, patients with hepatobiliary malignancies should be given priority to vaccinate the new crown vaccine according to the age of the patient, the stage of the malignant tumor, and comorbidities

For CLD patients, there is currently no specific evidence to show that there is a conflict between the safety of the new crown vaccine and protective immunity
.

Given that patients with liver cirrhosis and hepatobiliary malignancies are at high risk of serious consequences after being infected with new crowns, whether for patients or medical institutions, the benefits of vaccinating these patients with new crowns are likely to outweigh the risks of vaccination itself

Therefore, experts believe that CLD patients should be vaccinated against the new crown vaccine, and patients with advanced liver disease, liver decompensation and hepatobiliary malignancies should be given priority
.

Finally, in view of the relatively weak immune response of CLD patients to the new crown vaccine, it is recommended that their family members and related medical staff also be vaccinated with the new crown vaccine to reduce the risk of exposure

Recommendations for the application of the new crown vaccine in patients with liver transplantation

Based on general principles and previous experience in the application of other vaccines, it is recommended that patients be vaccinated against the new crown before liver transplantation as much as possible
.
Since the current phase III clinical trials of the vaccine exclude organ transplant recipients and people taking immunosuppressants, future clinical trials should include such patients
.

Based on current data, it is still difficult to determine which vaccine is appropriate for liver transplant patients
.
The potential side effects, safety and long-term immunogenicity of these new crown vaccines for liver transplant patients are worthy of attention
.

Before obtaining more conclusive safety data, individualized assessment of the benefits and risks of immunization of the immunosuppressed population with the new crown vaccine should be carried out
.
It is currently believed that for patients after liver transplantation, immunosuppression itself is not an independent risk factor for the adverse process of new coronary disease, but age and comorbidities determine the size of the individual's risk.
These factors are very common in liver transplant patients
.
Early after transplantation, the body is in the strongest immunosuppressive state, and the immune response to the vaccine may be weakened.
Therefore, it should be considered 3-6 months after transplantation and vaccination when immunosuppression is reduced
.

in conclusion

Phase III clinical trial results show that the approved vaccine has good immunogenicity and short-term safety in healthy people ≥16 years old, and its safety and effectiveness in CLD, hepatobiliary malignancies and immunocompromised people after liver transplantation There have been no negative reports on sex yet
.
Considering that CLD, hepatobiliary malignancies and immunosuppressed patients are at high risk of serious consequences after being infected with the new crown, the potential benefits of vaccination for these patients and medical staff may be greater than the risks of vaccination itself, so it is recommended for CLD and hepatobiliary malignancies And patients waiting for liver transplantation are vaccinated against the new crown vaccine, and priority is given to patients with serious risk factors for the development of new crown
.
The best time for vaccination after organ transplantation is uncertain.
It is recommended to vaccinate 3-6 months after transplantation
.

Finally, two points need to be emphasized
.
First, once the new crown vaccine is applied to the above patients, attention should be paid to monitoring the humoral and cellular immune response and infection rate after different vaccines and different doses of inoculation
.
Second, even if the above-mentioned patients and their close contacts are vaccinated with the new crown vaccine, they should still wear masks, wash their hands properly and maintain proper social distancing in their daily lives, because it is not certain whether vaccination can provide sufficient protective immunity and blockade.
The risk of infection from asymptomatic infected persons
.

Temporary summary of main recommendations

(1) It is recommended that recipients of CLD, hepatobiliary malignancies and liver transplantation receive the new crown vaccine
.

(2) It is recommended that the following patients receive the new crown vaccine as a priority: ①Patients with liver cirrhosis or liver function decompensation; ②Patients with hepatobiliary malignancies; ③CLD patients with high-risk factors for severe COVID-19; ④Liver transplantation with high-risk factors for severe COVID-19 Taker
.

(3) It is recommended that family members of liver cirrhosis, liver and gallbladder malignant tumors, liver transplant recipients, and medical and health care personnel who take care of the patients should be given priority to vaccinate the new crown vaccine
.

(4) A prospective registration system should be established as soon as possible to monitor the safety, immunogenicity and effectiveness of different new crown vaccines in CLD and organ transplant recipients
.

Reference materials:

1.
GENG JB, YU YC.
An excerpt of EASL position pa per on the use of COVID -19 vaccines in patients with chronic liver diseases, hepatobiliary cancer and liver transplant recipi ents (2021)[J].
J Clin Hepatol, 2021, 37(7): 1550 -1552.

2.
Geng Jiabao, Yu Lecheng.
2021 European Society of Liver Disease Expert Position Statement: Chronic Liver Diseases, Hepatobiliary Malignancies, and Liver Transplant Recipients COVID-19 Vaccination [J].
Journal of Clinical Hepatobiliary Diseases, 2021, 37(07):1550-1552.

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