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High antibody response in relation to immunosuppressive blood levels in liver transplant recipients after SARS-CoV-2 vaccination: an observational, cohort study
  1. Midas B Mulder1,2,
  2. Annemiek A van der Eijk3,
  3. Corine H GeurtsvanKessel3,
  4. Nicole S Erler4,5,
  5. Brenda C M de Winter1,2,
  6. Wojciech G Polak2,6,
  7. Herold J Metselaar2,7,
  8. Caroline M den Hoed2,7
  1. 1 Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
  2. 2 the Erasmus MC Transplant Institute, Erasmus MC Transplant Institute, Rotterdam, The Netherlands
  3. 3 Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands
  4. 4 Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
  5. 5 Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
  6. 6 Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
  7. 7 Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Mr Midas B Mulder, Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, Zuid-Holland, Netherlands; m.b.mulder{at}

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We read with great interest the recent publication from Siegel and colleagues, reporting recommendations from an international consensus meeting for SARS-CoV-2 vaccination in patients with inflammatory bowel diseases (IBDs).1 Based on experiences with other vaccines, it is reported that several immunosuppressive agents are associated with suboptimal vaccine response in patients with IBD.

We assessed the effect of immunosuppressive blood levels on the SARS-CoV-2-specific immunogenicity of SARS-CoV-2 vaccination in liver transplant (LT) recipients vaccinated with two doses of the mRNA vaccines: BNT162b2 or mRNA-1273 or the vector vaccine ChAdOx1 nCoV-19. Excluded were patients with a history of a SARS-CoV-2 infection.

A total of 476 LT recipients (476/795=59.9% of all alive recipients) were eligible for analysis between March and July 2021 at the Erasmus University Medical Centre (Rotterdam, the Netherlands). In total, 36 LT recipients had a history of a SARS-CoV-2 infection confirmed by PCR before vaccination, 128 LT recipients were not vaccinated and 155 LT recipients were not routinely seen at the outpatient clinic during the study period and, therefore, excluded from this analysis. Immunogenicity to vaccination was measured by using the Liaison SARS-CoV-2 TrimericS IgG assay (DiaSorin, Italy). Table 1 presents the …

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  • Contributors MM, HM and CdH designed the study. MM, AAvdE, CHG, HM and CdH were involved in the execution of the study. MM, CHG and CdH accessed and verified the underlying data. MM and NE analysed the data. MM wrote the manuscript with input from all other authors. All authors participated in data interpretation, manuscript writing, review and approval of the final version of the manuscript for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.