Antibody response to the messenger RNA‐1273 vaccine (Moderna) in liver transplant recipients : Hepatology Communications

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Antibody response to the messenger RNA‐1273 vaccine (Moderna) in liver transplant recipients

Cuadrado, Antonio*,1,2; del Barrio, María1,2; Fortea, José Ignacio1,2; Amigo, Lidia1,2; San Segundo, David3; Rodriguez‐Cundin, María Paz4; Rebollo, María Henar4; Fernandez‐Santiago, Roberto5,6; Castillo, Federico5,6; Achalandabaso, Maria5,6; Echeverri, Juan5,6; Anderson, Edward J.5,6; Rodríguez‐Sanjuan, Juan Carlos5,6; López‐Hoyos, Marcos3; Crespo, Javier1,2; Fábrega, Emilio1,2

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Hepatology Communications 6(7):p 1673-1679, July 2022. | DOI: 10.1002/hep4.1937
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Cuadrado A, del Barrio M, Fortea JI, Amigo L, San Segundo D, Rodriguez‐Cundin MP, et al. Antibody response to the messenger RNA‐1273 vaccine (Moderna) in liver transplant recipients. Hepatol Commun. 2022;6:1673–1679., del BarrioM, ForteaJI, AmigoL, San SegundoD, Rodriguez‐CundinMP, et al. Antibody response to the messenger RNA‐1273 vaccine (Moderna) in liver transplant recipients. Hepatol Commun. 2022;6:1673–1679.

Funding informationNo source of funding to declare


Several vaccines have been designed against the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus, with different mechanisms of action. The major target for most vaccines is the viral spike protein and its receptor‐binding domain interaction with human angiotensin‐converting enzyme 2 receptor, which is the mechanism of viral entry into human epithelial cells.[1] In the specific case of the messenger RNA (mRNA) SARS‐CoV‐2 vaccines, they are based on synthetic mRNA that encodes a variant of the spike glycoprotein, which is encapsulated in lipid nanoparticles for efficient delivery. The safety and efficacy of the mRNA SARS‐CoV‐2 vaccines (Moderna and Pfizer/BioNTech) among the general population has been demonstrated in several clinical trials, with protection rates as high as 95%.[2–4]

Solid organ transplant recipients (SOTRs) were excluded from these clinical trials, and therefore efficacy, durability, and safety data are scarce for this population. The occurrence of severe and fatal cases of corona virus disease 2019 (COVID‐19) in some vaccinated transplant recipients suggests a suboptimal humoral response.[5–7] In fact, recent published data showed markedly attenuated antibody responses and low antibody titers in SOTRs after two doses of an mRNA vaccine against SARS‐CoV‐2 (18%‐59%), with a relative difference in responses between the Pfizer/BioNTech and Moderna vaccines that resulted in less frequent antibody responses in SOTRs receiving the Pfizer/BioNTech vaccine.[8–13]

Recently, results of Pfizer/BioNTech vaccination in liver transplant recipients (LTRs) have been reported. In this Israeli study,[14] 80 LTRs and 25 healthy controls were included. Results showed that only 47.5% of the LTRs had a positive serology 10–20 days after receiving the second dose and that antibody titers were significantly lower than in healthy subjects.[14]

In Cantabria (northern Spain), the LTR vaccination campaign was started in April 2021. Most LTRs received the Moderna vaccine at the Preventive Medicine Department of the Marqués de Valdecilla University Hospital. The aim of the present study was to evaluate the antibody response following two doses (100 μg) of the mRNA‐1273 vaccine (Moderna) with a 28‐day interval in LTRs.


Study design and population

We retrospectively included all LTRs undergoing regular follow‐up at the Liver Transplant unit of our hospital (Marqués de Valdecilla University Hospital) and who had received two doses of the mRNA‐1273 COVID‐19 vaccine (Moderna) administered in the deltoid region following the standard protocol, between April 14 and May 18, 2021.

Combined liver and renal transplantation, prior or current diagnosis of COVID‐19, having received a different vaccine against SARS‐CoV‐2, and not having the antibody quantification test result before August 1, 2021, were considered criteria for exclusion.

Clinical data, including comorbidities and the immunosuppressive regimen, were obtained from the medical records of each LTR as were routine blood tests up to 3 months before the date of the first vaccination. Definition and classification of chronic kidney disease were performed according to Kidney Disease: Improving Global Outcomes (KDIGO) recommendations.[15]

The study was approved by the Institutional Ethics Committee of Cantabria (internal code, 2021.272) and complied with the provisions of the Good Clinical Practice guidelines and Declaration of Helsinki.

SARS‐CoV‐2 antibodies test

Antibody response was semiquantitatively assessed using serum samples analyzed on the Alinity i platform (Abbott Laboratories) using the SARS‐CoV‐2 anti‐spike protein immunoglobulin G (IgG) II assay. Following manufacturer guidelines, titers >50 arbitrary units (AU)/mL were interpreted as positive (detection range, 6.8–80.000 AU/mL; positive agreement, 92.9%; negative agreement, 99.9%). Results of this assay have been shown to correlate with in vitro neutralization of SARS‐CoV‐2.[16]

Statistical analysis

Quantitative variables were expressed as mean (SD) or median (range or interquartile range [IQR]) according to data distribution and qualitative variables as absolute value and proportions. Comparisons between groups were performed with the unpaired Student t test, Mann‐Whitney U test, or Fisher's exact test, as appropriate. Adjusted association with serologic response was investigated with logistic regression analysis by introducing variables that were related to the latter in a univariate analysis (p < 0.1) or that were considered clinically significant regardless of the p value. The maximum number of variables included in the multivariable analysis was one per 5–10 outcomes. The strength of the association of each variable with the response was estimated with the odds ratio (OR) with its 95% confidence interval (CI). Statistical significance was defined as p < 0.05. Statistical analysis was performed with IBM SPSS Statistics v22.0 for Apple Macintosh (IBM Corp, Armonk, NY).


Baseline characteristics

During the study period, 166 LTRs received two doses of the Moderna vaccine. A total of 37 patients were excluded from the analysis (7 patients with combined liver and renal transplantation; 3 patients with prior COVID‐19 infection; and 27 patients without an antibody quantification result). Therefore, 129 LTRs were included in this study; their baseline characteristics are summarized in Table 1. All patients were Caucasian, and most patients were men (n = 99; 76.7%) with a median age of 63 years (IQR, 56–68). Alcohol (56; 43.4%) and chronic hepatitis C (24; 18.6%) were the most frequent etiologies, being the decompensation of cirrhosis (61; 47.3%), which is the main indication for liver transplantation, followed by hepatocellular carcinoma (52; 40.3%).

TABLE 1 - Baseline characteristics of LTRs and comparison of LTRs with positive‐ and negative‐SARS‐CoV‐2 IgG serology
Variables All LTRs (n= 129) Seropositive (n= 113) Seronegative (n= 16) p
Age, years; median (IQR) 63 (56–68) 63 (56–68) 63.5 (52.8–68) 0.71
Sex (male) 99 (76.7) 88 (77.8) 11 (68.8) 0.42
Race (Caucasian) 129 (100) 113 (100) 16 (100)
Etiology of liver disease 0.16
Alcohol 56 (43.4) 50 (44.2) 6 (37.5%)
HCV 24 (18.6) 22 (19.5) 2 (12.5)
Alcohol + HCV 12 (9.3) 12 (10.6) 0 (0)
Other 37 (28.7) 29 (25.7) 8 (50)
Transplant indication 0.37
Hepatocellular carcinoma 52 (40.3) 48 (42.5) 4 (25)
Decompensated cirrhosis 61 (47.3) 52 (46) 9 (56.3)
Other 16 (12.4) 13 (11.5) 3 (18.8)
Interval since transplantation, years; n (%) 0.07
<1 8 (6.2) 5 (4.4) 3 (18.8)
1–3 15 (11.6) 13 (11.5) 2 (12.5)
3–6 30 (23.3) 28 (24.8) 2 (12.5)
6–11 29 (22.5) 28 (24.8) 1 (6.3)
>11 47 (36.4) 39 (34.5) 8 (50)
ABO group 0.93
A 53 (51) 48 (50.5) 5 (55.6)
B 8 (7.7) 7 (7.4) 1 (11.1)
AB 2 (1.9) 2 (2.1) 0 (0)
0 41 (39.4) 38 (40) 3 (33.3)
Previous medical history
Hypertension 78 (60.5) 68 (60.2) 10 (62.5) 0.86
Diabetes 47 (36.4) 39 (34.5) 8 (50) 0.23
Chronic kidney disease 46 (35.9) 35 (31.0) 11 (68.8) 0.003*
Cardiovascular disease 34 (26.4) 33 (29.2) 1 (6.3) 0.051
Chronic lung disease 12 (9.3) 12 (10.6) 0 (0) 0.17
Immunosuppressive regimen 0.001*
Without mycophenolate 97 (75.2) 93 (82.3) 4 (25)
Monotherapy [CNI/imTOR] 91 [85/6] (70.5) 89 [83/6] (78.8) 2 [2/0] (12.5)
Association with CNI a 6 (4.7) 4 (3.5) 2 (12.5)
With mycophenolate 32 (24.8) 20 (17.7) 12 (75)
Monotherapy 8 (6.2) 2 (1.8) 6 (37.5)
Association with CNI 24 (18.6) 18 (15.9) 6 (37.5)
Immunosuppression, dose in mg; mean (SD)
Mycophenolate (n = 32) 1093.8 (482.6) 875.0 (222.1) 1458.3 (582.3) 0.003*
Prednisone (n = 3) 4.2 (2.9) 5 (3.5) 2.5 0.48
Immunosuppression, trough concentration µg/L; mean (SD)
Cyclosporine (n = 12) 66.9 (33.9) 66.9 (33.9)
Tacrolimus (n = 103) 4.9 (1.4) 4.9 (1.4) 5.1 (2.1) 0.56
Everolimus (n = 10) 4.8 (1.6) 4.9 (1.24) 4.6 (3.7) 0.02*
Laboratory parameters, mean (SD)
Hemoglobin (g/dL) 14.1 (1.8) 14.1 (1.8) 13.4 (1.9) 0.78
Platelets (×103/µL) 172.5 (56.9) 174.5 (57.3) 158.6 (54.4) 0.48
Leukocytes (×103/µL) 5.9 (1.8) 6.2 (1.8) 4.8 (1.6) 0.007*
Lymphocytes (×103/µL) 1.7 (0.7) 1.8 (0.7) 1.3 (0.9) 0.001*
Ratio Le/Ly 3.8 (1.5) 3.7 (1.3) 4.6 (2.4) 0.04*
eGFR (mL/minute/1.73 m2) 70.1 (18.5) 71.9 (17.3) 58 (22.4) 0.02*
Serum creatinine (mg/dL) 1.1 (0.4) 1.1 (0.3) 1.4 (0.5) 0.005*
Serum albumin (g/dL) 4.4 (0.3) 4.4 (0.3) 4.5 (0.2) 0.13
Days between vaccine and serologic test, median (IQR) 43 (37–49) 43.0 (37.0–50.5) 42 (37.0–47.8) 0.48
Qualitative variables are expressed as n (%).
Abbreviations: CNI, calcineurin inhibitors; eGFR, estimated glomerular filtration rate; HCV, hepatitis C virus; IgG, immunoglobulin G; imTOR, mammalian target of rapamycin inhibitors; IQR, interquartile range; Le/Ly, ratio leukocytes/lymphocytes; LTR, liver transplant recipient; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2.
aCNI was associated with prednisone, imTOR, or both.
*Levels are significant.

Comorbidities were common in LTRs, with 94.9% diagnosed with at least one comorbidity, such as arterial hypertension (78; 60.5%), diabetes (47; 36.4%), or chronic kidney disease (46; 35.9%).

Regarding immunosuppressive therapy before vaccination, calcineurin inhibitors (CNIs) were used as the backbone of the immunosuppressive regimen in 115 LTRs (89.1%). Everolimus was used in 10 LTRs (7.8%), and mycophenolate mofetil (MMF) was used in 32 LTRs (24.8%), 8 of whom received the latter as monotherapy. Mean CNIs and everolimus serum levels and mean daily MMF dose are presented in Table 1.

Antibody response and titers after SARS‐CoV‐2 vaccination

The median time between liver transplantation and vaccination was 7.0 years (IQR, 4–12). Serum samples for SARS‐CoV‐2 IgG antibodies were tested in a median of 43 days (IQR, 37–49) after the second intramuscular vaccination dose.

A positive antibody response was observed in 113 LTRs (87.6%; 95% CI, 80.8–92.2), while 16 patients remained negative (12.4%; 95% CI, 7.8–19.2). Among LTR responders, median titers of anti‐spike 1 IgG were 4792.0 AU/mL (IQR, 1414.0–14,390.0 AU/mL). Comparison of the clinical and laboratory data of LTRs with positive and negative response to the Moderna vaccine is presented in Table 1. Age and sex distribution, cause of liver disease, and indication for liver transplantation were similar in both groups. No association was found between posttransplant time and serologic response. Patients who did not have an antibody response presented chronic kidney disease more frequently (68.8%; 95% CI, 44.4%–85.9% versus 31.0%; 95% CI, 23.2%–40.0%; p = 0.003) than responders and higher mean serum creatinine levels (1.4; 95% CI, 1.1–1.7 versus 1.1; 95% CI, 1.0–1.1 mg/dL; p = 0.005). Nonresponse was also associated with MMF treatment (75%; 95% CI, 50.5%–89.8% versus 17.7%; 95% CI, 11.8%–25.8%, p = 0.001) and a higher dose of MMF (Table 1). Moreover, the mean absolute count of leukocytes and lymphocytes was lower in nonresponders (leukocytes × 103/µL, 4.8; 95% CI, 4.0–5.7 versus 6.2; 95% CI, 5.8–6.5; p = 0.007 and lymphocytes × 103/µL, 1.3; 95% CI, 0.8–1.8 versus 1.8; 95% CI, 1.7–1.9; p = 0.001). Finally, the ratio of leukocytes to lymphocytes showed an inverse relationship with antibody response (nonresponders, 4.6; 95% CI, 3.3–5.8 versus responders, 3.7; 95% CI, 3.4–3.9; p = 0.04).

In the multivariate analysis, an immunosuppressive regimen containing mycophenolate (OR, 0.08; 95% CI, 0.02–0.29; p = 0.001) was the factor most strongly associated with an absence of a serologic response (Table 2). Although the absolute lymphocyte count was also associated with the immune response, the effect turned out to be practically neutral (OR, 1.0; 95% CI, 1.0–1.0; p = 0.046).

TABLE 2 - Factors associated with the serologic response to the SARS‐CoV‐2 vaccine
Variable Univariant Multivariant
OR (95% CI) p OR (95% CI) p
Age (increase by year) 1.1 (0.9 –1.1) 0.16
Time since transplantation (increase by year) 1.0 (0.9–1.1) 0.86
Immunosuppressive regimen (reference, without mycophenolate) 0.07 (0.02–0.25) 0.001 0.08 (0.02–0.29) 0.001
Mycophenolate dose (increase by mg) 1.0 (1.0–1.0) 0.001
Tacrolimus trough concentration (increase by µg/L) 0.9 (0.6–1.4) 0.71
Everolimus trough concentration (increase by µg/L) 1.1 (0.4–3.1) 0.84
Leukocyte count (increase by 1 × 103/µL) 1.0 (1.0–1.0) 0.009
Lymphocyte count (increase by 1 × 103/µL) 1.0 (1.0–1.0) 0.010 1.0 (1.0–1.0) 0.046
Ratio Le/Ly (increase by unit) 0.7 (0.5–0.9) 0.04
Serum creatinine (increase by mg/dL) 0.2 (0.1–0.6) 0.004
Abbreviations: CI, confidence interval; Le/Ly, ratio leukocyte/lymphocyte; OR, odds ratio; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2.

When we divided responders into low and high responders based on a more conservative threshold of >4160 AU/mL (that has been shown to have 95% concordance with the gold‐standard plaque reduction neutralization test [PRNT]),[17,18] only the fact of having received MMF was (inversely) associated with the response (OR, 0.26; 95% CI, 0.09–0.8; p = 0.024).

At the time of writing this article, 3 patients who had received the complete vaccination schedule presented a SARS‐Cov‐2 infection during follow‐up, a median of 235 days (range, 203–238 days) after the second dose. Only 1 patient required hospitalization because of concurrent cholangitis related to a biliary anastomosis stricture. None of these patients developed respiratory or other COVID‐19‐related symptoms.


This study evaluated the serologic response of LTRs to the mRNA SARS‐CoV‐2 Moderna vaccine in a real‐life scenario. The Moderna vaccine induced a serologic response in 87.6% of LTRs.[8–13] In addition, the use of an immunosuppressive regimen containing MMF predicted a poor serologic response.

Recent data evaluating Pfizer‐BioNTech BNT162b2 SARS‐CoV‐2 vaccine immunogenicity in LTRs have shown protective levels of antibodies ranging between 47.5% and 79%.[14,19,20] The serologic response found in our study to the Moderna vaccine in LTRs (87.6%) indicates a good antibody response, and these results are in line with those recently published by Strauss et al.[21] in LTRs. Even so, response rate and antibody titers continue to be lower than those achieved in the general population.[2–4] This variable antibody response to different vaccines in LTRs may reflect differences in serologic assay sensitivities and not necessarily a higher efficacy of the Moderna vaccine.[8,9,22] Nevertheless, it could be speculated that the higher Moderna vaccine immunogenicity may be due to its higher dose (100 µg) compared to Pfizer/BioNTech (30 µg) in addition to its better thermostability and handling. These differences, although insignificant for immunocompetent individuals, might be important in patients with impaired immunity in whom strong stimuli are required.[21] Longitudinal studies indicate delayed IgG seroconversion and lower titers when individuals who are immunosuppressed suffer COVID‐19 illness.[23–25] Thus, another possible explanation for its higher success rate is that the response to vaccination may be delayed in patients who are immunosuppressed.[5] Indeed, while the median time from the second dose to the antibody assay was carried out in the first month in previous studies in SOTRs, in our case the median time was 43 days.[11,14,19,20,26]

Unlike other studies that have found an influence of age[9,14,19,23] or time elapsed since transplantation[14,19] on the serologic response to the vaccine, we did not observe this in our cohort. Moreover, although renal dysfunction was associated with a worse serologic response, it did not reach statistical significance in the multivariate analysis. It is possible that our study did not have sufficient statistical power to show this. Certainly, chronic kidney disease is associated with a proinflammatory state and immune dysfunction, which encompasses both the innate system and acquired immunity that could explain the worse serologic response observed in other studies.[8,14,27]

The influence of different immunosuppressive regimens on vaccination was explored in our study. In fact, the strongest predictive factor for the absence of serologic response, with an OR of 0.07 (95% CI, 0.02–0.26), was the use of MMF. This antimetabolite immunosuppressant has a well‐known suppressive effect on the immune system, including the inhibition of antibody production.[28] Our finding is in line with previous reports and suggests that immune paresis perhaps promoted by antimetabolite therapy is the most likely explanation.[4,8,9,14,19,20,22,23] Moreover, the absolute lymphocyte blood count before vaccination tended to be higher in responders, and the association was statistically significant in the multivariate analysis. Although the effect was very weak, probably related to a low statistical power of the study, it is plausible and consistent with studies supporting its implication for establishing a response to vaccination[20] as it occurs with the vaccines against influenza virus.[29]

The current data suggest that SOTRs might be vulnerable to COVID‐19 disease despite their vaccination status.[5–7] The correlation between antibody level after vaccination and clinical protection from COVID‐19 has not been proven, and antibody levels are difficult to interpret.[30] Therefore, low antibody response may imply an inadequate protective response (and perhaps of shorter duration), and further studies are needed in order to determine whether these patients with positive, albeit low, antibody levels possess a higher risk of SARS‐CoV‐2 infection. Some studies have applied a more conservative threshold of >4160 AU/mL as this has been shown to have 95% concordance with the gold‐standard PRNT.[17,18] A recent such study by Narasimhan et al.[13] observed that vaccinated patients with a lung transplant without prior infection that mounted an antibody response appeared to generate a response not comparable to that of a neutralizing antibody titer. Applying this cutoff to our study, only 63 patients (49.6%; 95% CI, 41.1%–58.2%) had shown neutralizing antibody titers. These data could mean that a greater number of LTRs are really unprotected. That said, antibody titers may not be a sufficient measure of protection against COVID‐19 in patients with chronic liver diseases and LTRs. Although reports of cellular immunity in SOTRs are scarce, cellular immunity probably plays an important role in the control of SARS‐CoV‐2 infection, and a recent report suggests that heart and liver transplant recipients develop adequate humoral or cellular responses to an mRNA vaccine.[31] Taking all these considerations into account, on September 7, 2021, the Spanish National Health Authority decided to administer a third dose of booster vaccine to all SOTRs and other patients who were immunocompromised, regardless of serologic evaluation, at least 4 weeks after the second dose. All LTRs included in the study received a third homologous dose of the mRNA‐1273 SARS‐CoV‐2 vaccine between September 27 and October 10, 2021.

Although it was not an objective of our study, only 3 patients who had received the complete vaccination schedule presented a SARS‐Cov‐2 infection during follow‐up, and only 1 of these patients required hospitalization because of a concurrent cholangitis related to a biliary anastomosis stricture. None of these patients developed respiratory or other COVID‐19‐related symptoms. These findings appear to be consistent with a recently published paper reporting that SARS‐CoV‐2 vaccination reduces severe disease in patients with cirrhosis and SOTRs.[32]

Some of the limitations of our study are related to the retrospective design and the absence of a control group. However, there are extensive and consistent data in large clinical trials regarding efficacy of vaccine in healthy individuals.[2–4] Other limitations are the absence of serial measurements after vaccination, short time of follow‐up, and lack of exploration of neutralizing antibody and/or cellular responses.

In conclusion, our data reveal a high response rate to the administration of the Moderna vaccine in LTRs. Immunosuppressive treatment, including MMF, was the strongest factor associated with a poor serologic response.


The authors declare no personal or financial conflict of interest pertaining to this work.


We express our gratitude and respect to the patients, who have shown great patience and resilience during this terrible COVID‐19 pandemic.


1. Wiersinga WJ, Rhodes A, Cheng AC, Peacock SJ, Prescott HC. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID‐19): a review. JAMA. 2020;324:782–93.
2. Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al.; COVE Study Group . Efficacy and safety of the mRNA‐1273 SARS‐CoV‐2 vaccine. N Engl J Med. 2021;384:403–16.
3. Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al.; C4591001 Clinical Trial Group . Safety and efficacy of the BNT162b2 mRNA COVID‐19 vaccine. N Engl J Med. 2020;383:2603–15.
4. Thompson MG, Burgess JL, Naleway AL, Tyner H, Yoon SK, Meece J, et al. Prevention and attenuation of COVID‐19 with the BNT162b2 and mRNA‐1273 vaccines. N Engl J Med. 2021;385:320–9.
5. Ali NM, Alnazari N, Mehta SA, Boyarsky B, Avery RK, Segev DL, et al. Development of COVID‐19 infection in transplant recipients after SARS‐CoV‐2 vaccination. Transplantation. 2021;105:e104–e6.
6. Havlin J, Svorcova M, Dvorackova E, Lastovicka J, Lischke R, Kalina T, et al. Immunogenicity of BNT162b2 mRNA COVID‐19 vaccine and SARS‐CoV‐2 infection in lung transplant recipients. J Heart Lung Transplant. 2021;40:754–8.
7. Wadei HM, Gonwa TA, Leoni JC, Shah SZ, Aslam N, Speicher LL. COVID‐19 infection in solid organ transplant recipients after SARS‐CoV‐2 vaccination. Am J Transplant. 2021;21:3496–9.
8. Benotmane I, Gautier‐Vargas G, Cognard N, Olagne J, Heibel F, Braun‐Parvez L, et al. Weak anti‐SARS‐CoV‐2 antibody response after the first injection of an mRNA COVID‐19 vaccine in kidney transplant recipients. Kidney Int. 2021;99:1487–9.
9. Boyarsky BJ, Werbel WA, Avery RK, Tobian AAR, Massie AB, Segev DL, et al. Antibody response to 2‐dose SARS‐CoV‐2 mRNA vaccine series in solid organ transplant recipients. JAMA. 2021;325:2204–6.
10. Kho MML, Reinders MEJ, Baan CC, van Baarle D, Bemelman FJ, Diavatopoulos DA, et al.; RECOVAC Collaborators . The RECOVAC IR study: the immune response and safety of the mRNA‐1273 COVID‐19 vaccine in patients with chronic kidney disease, on dialysis, or living with a kidney transplant. Nephrol Dial Transplant. 2021;36(9):1761–4.
11. Korth J, Jahn M, Dorsch O, Anastasiou OE, Sorge‐Hädicke B, Eisenberger U, et al. Impaired humoral response in renal transplant recipients to SARS‐CoV‐2 vaccination with BNT162b2 (Pfizer‐BioNTech). Viruses. 2021;13:756.
12. Malinis M, Cohen E, Azar MM. Effectiveness of SARS‐CoV‐2 vaccination in fully vaccinated solid organ transplant recipients. Am J Transplant. 2021;21:2916–8.
13. Narasimhan M, Mahimainathan L, Clark AE, Usmani A, Cao J, Araj E, et al. Serological response in lung transplant recipients after two doses of SARS‐CoV‐2 mRNA vaccines. Vaccines (Basel). 2021;9:708.
14. Rabinowich L, Grupper A, Baruch R, Ben‐Yehoyada M, Halperin T, Turner D, et al. Low immunogenicity to SARS‐CoV‐2 vaccination among liver transplant recipients. J Hepatol. 2021;75:435–8.
15. KDIGO . KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl [Internet]. 2013 Jan [cited Aug 2021];3(1):1–150. Available from:‐content/uploads/2017/02/KDIGO_2012_CKD_GL.pdf
16. Perkmann T, Perkmann‐Nagele N, Koller T, Mucher P, Radakovics A, Marculescu R, et al. Anti‐spike protein assays to determine SARS‐CoV‐2 antibody levels: a head‐to‐head comparison of five quantitative assays. Microbiol Spectr. 2021;9:e0024721.
17. Ebinger JE, Fert‐Bober J, Printsev I, Wu M, Sun N, Prostko JC, et al. Antibody responses to the BNT162b2 mRNA vaccine in individuals previously infected with SARS‐CoV‐2. Nat Med. 2021;27:981–4.
18. Kohmer N, Ruhl C, Ciesek S, Rabenau HF. Utility of different surrogate enzyme‐linked immunosorbent assays (sELISAs) for detection of SARS‐CoV‐2 neutralizing antibodies. J Clin Med. 2021;10:2128.
19. Guarino M, Cossiga V, Esposito I, Alessandro F, Morisco F. Effectiveness of SARS‐Cov‐2 vaccination in liver transplanted patients: the debate is open! J Hepatol. 2022;76:237–9.
20. Rashidi‐Alavijeh J, Frey A, Passenberg M, Korth J, Zmudzinski J, Anastasiou OE, et al. Humoral response to SARS‐Cov‐2 vaccination in liver transplant recipients‐a single‐center experience. Vaccines (Basel). 2021;9:738.
21. Strauss AT, Hallett AM, Boyarsky BJ, Ou MT, Werbel WA, Avery RK, et al. Antibody response to severe acute respiratory syndrome‐coronavirus‐2 messenger RNA vaccines in liver transplant recipients. Liver Transpl. 2021;27:1852–6.
22. Grupper A, Rabinowich L, Schwartz D, Schwartz IF, Ben‐Yehoyada M, Shashar M, et al. Reduced humoral response to mRNA SARS‐CoV‐2 BNT162b2 vaccine in kidney transplant recipients without prior exposure to the virus. Am J Transplant. 2021;21:2719–26.
23. Anderson EJ, Rouphael NG, Widge AT, Jackson LA, Roberts PC, Makhene M, et al.; mRNA‐1273 Study Group . Safety and immunogenicity of SARS‐CoV‐2 mRNA‐1273 vaccine in older adults. N Engl J Med. 2020;383:2427–38.
24. Cornberg M, Eberhardt CS. Protected or not protected, that is the question ‐ first data on COVID‐19 vaccine responses in patients with NAFLD and liver transplant recipients. J Hepatol. 2021;75:265–6.
25. Orner EP, Rodgers MA, Hock K, Tang MS, Taylor R, Gardiner M, et al. Comparison of SARS‐CoV‐2 IgM and IgG seroconversion profiles among hospitalized patients in two US cities. Diagn Microbiol Infect Dis. 2021;99:115300.
26. Boyarsky BJ, Chiang TP‐Y, Ou MT, Werbel WA, Massie AB, Segev DL, et al. Antibody response to the Janssen COVID‐19 vaccine in solid organ transplant recipients. Transplantation. 2021;105:e82–e3.
27. Kamar N, Abravanel F, Marion O, Couat C, Izopet J, Del Bello A. Three doses of an mRNA Covid‐19 vaccine in solid‐organ transplant recipients. N Engl J Med. 2021;385:661–2.
28. Smith KG, Isbel NM, Catton MG, Leydon JA, Becker GJ, Walker RG. Suppression of the humoral immune response by mycophenolate mofetil. Nephrol Dial Transplant. 1998;13:160–4.
29. Mavinkurve‐Groothuis AM, van der Flier M, Stelma F, van Leer‐Buter C, Preijers FW, Hoogerbrugge PM. Absolute lymphocyte count predicts the response to new influenza virus H1N1 vaccination in pediatric cancer patients. Clin Vaccine Immunol. 2013;20:118–21.
30. Harvey RA, Rassen JA, Kabelac CA, Turenne W, Leonard S, Klesh R, et al. Association of SARS‐CoV‐2 seropositive antibody test with risk of future infection. JAMA Intern Med. 2021;181:672–9.
31. Herrera S, Colmenero J, Pascal M, Escobedo M, Castel MA, Sole‐González E, et al. Cellular and humoral immune response after mRNA‐1273 SARS‐CoV‐2 vaccine in liver and heart transplant recipients. Am J Transplant. 2021;21:3971–9.
32. Moon AM, Webb GJ, Garcia‐Juarez I, Kulkarni AV, Adali G, Wong DK, et al. SARS‐CoV‐2 infections among patients with liver disease and liver transplantation who received COVID‐19 vaccination. Hepatol Commun. 2021.
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