Saudi Journal of Gastroenterology
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Use of COVID-19 vaccines in patients with liver disease and post-liver transplantation: Position statement of the Saudi association for the study of liver diseases and transplantation


1 Liver Transplant Center, King Faisal Specialist Hospital and Research Center; Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD
2 Department of Internal Medicine, Division of Infectious Diseases, College of Medicine, King Saud University, Riyadh, Saudi Arabia
3 Research and Innovation Center, King Saud Medical City, Ministry of Health; College of Medicine, Alfaisal University, Riyadh; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
4 Department of Gastroenterology and Transplant Hepatology, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
5 Department of Infectious Disease, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
6 Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
7 Department of Medicine, College of Medicine, Gastroenterology and Hepatology Unit, King Saud University, Riyadh, Saudi Arabia
8 Department of Medicine, Division of Gastroenterology, and Multi-Organ Transplant Program, Western University and London Health Sciences Centre, London, Ontario; Division of Transplantation, University of Rochester, Rochester, NY
9 Division of Critical Care, Department of Medicine; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
10 Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
11 College of Medicine, Alfaisal University, Riyadh; Department of Medicine, Gastroenterology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia

Correspondence Address:
Saleh A Alqahtani,
Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh 12713
MD
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjg.sjg_223_21

Patients with chronic liver disease (CLD) and liver transplant recipients are at increased risk of morbidity and mortality from coronavirus disease 2019 (COVID-19). Although several studies demonstrated the safety and efficacy of COVID-19 vaccines in the general population, data in CLD patients and liver transplant recipients are lacking. Two COVID-19 vaccines were approved by the Saudi Food and Drug Authority and rolled out to several million recipients in Saudi Arabia. These vaccines are mRNA-based vaccine BNT162b2 from Pfizer/BioNTech and adenovirus-based AZD1222 from Oxford/AstraZeneca from three manufacturing sites (EU Nodes, Serum Institute of India, and South Korea Bio). The Saudi Association for the Study of Liver diseases and Transplantation (SASLT) has reviewed the available evidence and issued interim recommendations for COVID-19 vaccination in CLD and liver transplant recipients. Since there is no evidence contradicting the safety and immunogenicity of the currently approved COVID-19 vaccines in patients with CLD and hepatobiliary cancer and liver transplant recipients, the SASLT recommends vaccination in those patient populations. CLD and hepatobiliary cancer patients and liver transplant recipients should be prioritized depending on the risk factors for severe COVID-19. In transplant recipients, the optimal timing of vaccination remains unknown; however, immunization is recommended after the initial immunosuppression phase. Patients with CLD and liver transplant candidates or recipients should be closely monitored after COVID-19 vaccination. These patient populations should be included in future clinical trials to provide further evidence on the efficacy and safety of COVID-19 vaccines.


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    -  Alqahtani SA
    -  Barry M
    -  Memish Z
    -  Hashim A
    -  Alfares MA
    -  Alghamdi SA
    -  Al-Hamoudi WK
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