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

Anna Herting; Jacqueline Jahnke-Triankowski; Aenne Harberts; Golda M. Schaub; Marc Lütgehetmann; Darius F. Ruether; Lutz Fischer; Marylyn M. Addo; Ansgar W. Lohse; Julian Schulze zur Wiesch; Martina Sterneck

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

2023

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 (n = 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: p &lt: 0.001), had a higher Charlson comorbidity index (9 vs. 5: p &lt: 0.001), and a lower anti-S RBD titer (Roche Elecsys) prior to infection (508.3 AU/mL vs. 2044 AU/mL: p = 0.03). Long-lasting symptoms for &ge:4 weeks were reported by 37.5% of LTR (30/80). Risk factors in LTR included female sex (p = 0.01: Odds Ratio (OR) = 4.92 (95% confidence interval (CI) (1.5&ndash:16.5)) and dyspnea (p = 0.009: OR = 7.2 (95% CI (1.6&ndash: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 (p &lt: 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.

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