{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T17:16:52Z","timestamp":1788542212863,"version":"build-2803163510"},"reference-count":20,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T00:00:00Z","timestamp":1745452800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Vaccines"],"abstract":"<jats:p>Background: Bergamo was the most severely affected Italian province at the onset of the 2020 COVID-19 pandemic. The liver transplant (LT) patient population should be among the more sensitized to the concept of health prevention. Long-term data on both perception and outcomes of SARS-CoV-2 vaccination in LT recipients since the COVID-19 vaccine became available in Italy are still lacking. Methods: From May to October 2023, a survey on actively followed LT recipients at our institution was carried on by the local patient\u2019 advocacy (Associazione Amici del Trapianto di Fegato) to define the rate of vaccinated subjects, SARS-CoV-2 infections and self-reported COVID-19-related outcomes. Results: Out of the consecutive 753 adult LT recipients invited to the survey, 356 responded (47.3%) [71% male, 63 years old (20\u201385), LT performed a mean of 9 years (1\u201326) before vaccination] and were included in the analysis. All patients received the first vaccine dose between December 2020 and January 2022 (81.7% Cominarty\u00ae, 17.7% Spikevax\u00ae, 0.3% Vaxzevria\u00ae and 0.3% Jcovden\u00ae). In the following years, adherence to the vaccination policy decreased progressively over time: the second, third, fourth, and fifth vaccine doses were administered to 99%, 94%, 72%, and 22% of the LT population by October, 2023. In total, 43 (12%) and 93 (26%) patients reported a COVID-19 episode before and after [13 (7\u201321) months] the first vaccination, respectively; none of the LT recipients reported a second COVID-19 infection after the following vaccination cycles. Forty-six (13%) reported short-term post-vaccination mild adverse events but none developed either acute or chronic rejection episodes or hospitalization for COVID-19-related symptoms. A total of 64% of LT recipients resulted positive for anti-nucleocapsid serological test in 2023. Conclusions: COVID-19 vaccines are safe and effective in LT recipients, underlining once again the importance of vaccination in this special population at higher risk of complications from communicable infectious diseases.<\/jats:p>","DOI":"10.3390\/vaccines13050455","type":"journal-article","created":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T10:17:16Z","timestamp":1745489836000},"page":"455","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["COVID-19 Vaccine Perception in Liver Transplant Recipients: Patient-Reported Outcomes and Real-Life Experience from the Bergamo Center"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8022-8803","authenticated-orcid":false,"given":"Alessandro","family":"Loglio","sequence":"first","affiliation":[{"name":"Gastroenterology, Hepatology and Transplantation Division, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0371-0035","authenticated-orcid":false,"given":"Elisa","family":"Farina","sequence":"additional","affiliation":[{"name":"Gastroenterology, Hepatology and Transplantation Division, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Ideo","sequence":"additional","affiliation":[{"name":"Gastroenterology, Hepatology and Transplantation Division, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"},{"name":"Gastroenterology, Department of Medicine, University of Milano Bicocca, 20126 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Alfieri","sequence":"additional","affiliation":[{"name":"Associazione Amici del Trapianto di Fegato ODV (Ordine dei Volontari), 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziana","family":"Negri","sequence":"additional","affiliation":[{"name":"Associazione Amici del Trapianto di Fegato ODV (Ordine dei Volontari), 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2677-8967","authenticated-orcid":false,"given":"Flavia","family":"Neri","sequence":"additional","affiliation":[{"name":"Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6433-506X","authenticated-orcid":false,"given":"Valentina","family":"Zuccaro","sequence":"additional","affiliation":[{"name":"Department of Diagnostic, Paediatric, Clinical and Surgical Science, University of Pavia, 27100 Pavia, Italy"},{"name":"Department of Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8308-0701","authenticated-orcid":false,"given":"Stefano","family":"Fagiuoli","sequence":"additional","affiliation":[{"name":"Gastroenterology, Hepatology and Transplantation Division, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"},{"name":"Gastroenterology, Department of Medicine, University of Milano Bicocca, 20126 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3037-7904","authenticated-orcid":false,"given":"Stefania","family":"Camagni","sequence":"additional","affiliation":[{"name":"Department of Organ Failure and Transplantation, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0769-1767","authenticated-orcid":false,"given":"Mauro","family":"Vigan\u00f2","sequence":"additional","affiliation":[{"name":"Gastroenterology, Hepatology and Transplantation Division, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"},{"name":"Gastroenterology, Department of Medicine, University of Milano Bicocca, 20126 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1016\/j.jhep.2020.06.001","article-title":"High rates of 30-day mortality in patients with cirrhosis and COVID-19","volume":"73","author":"Iavarone","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1907","DOI":"10.1111\/ajt.15909","article-title":"Fatal outcome in a liver transplant recipient with COVID-19","volume":"20","author":"Huang","year":"2020","journal-title":"Am. J. Transplant."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"944","DOI":"10.1016\/j.jhep.2021.01.032","article-title":"EASL position paper on the use of COVID-19 vaccines in patients with chronic liver diseases, hepatobiliary cancer and liver transplant recipients","volume":"74","author":"Cornberg","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"101025","DOI":"10.1016\/j.eclinm.2021.101025","article-title":"Impact of COVID-19 on liver transplant recipients-A systematic review and metaanalysis","volume":"38","author":"Kulkarni","year":"2021","journal-title":"EClinical Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"P643","DOI":"10.1016\/S2468-1253(20)30125-4","article-title":"Determining risk factors for mortality in liver transplant patients with COVID-19","volume":"5","author":"Webb","year":"2020","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1002\/hep.31751","article-title":"American Association for the Study of Liver Diseases Expert Panel Consensus Statement: Vaccines to Prevent Coronavirus Disease 2019 Infection in Patients with Liver Disease","volume":"74","author":"Fix","year":"2021","journal-title":"Hepatology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1016\/j.dld.2021.03.013","article-title":"Italian association for the study of the liver position statement on SARS-CoV2 vaccination","volume":"53","author":"Russo","year":"2021","journal-title":"Dig. Liver Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Vigan\u00f2, M., Beretta, M., Lepore, M., Abete, R., Benatti, S.V., Grassini, M.V., Camagni, S., Chiodini, G., Vargiu, S., and Vittori, C. (2023). Vaccination Recommendations in Solid Organ Transplant Adult Candidates and Recipients. Vaccines, 11.","DOI":"10.20944\/preprints202307.1805.v1"},{"key":"ref_9","unstructured":"European Medicines Agency (2025, April 04). Treatments and Vaccines for COVID-19. Available online: https:\/\/commission.europa.eu\/strategy-and-policy\/coronavirus-response\/safe-covid-19-vaccines-europeans_en."},{"key":"ref_10","unstructured":"FDA (2025, April 10). COVID-19 Vaccines: The FDA Has Regulatory Processes in Place to Facilitate the Development of COVID-19 Vaccines that Meet the FDA\u2019s Rigorous Scientific Standards, Available online: https:\/\/www.fda.gov\/vaccines-blood-biologics\/industry-biologics\/coronavirus-covid-19-cber-regulated-biologics."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1016\/j.jhep.2022.07.008","article-title":"Impact of COVID-19 on the liver and on the care of patients with chronic liver disease, hepatobiliary cancer, and liver transplantation: An updated EASL position paper","volume":"77","author":"Marjot","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e0273","DOI":"10.1097\/HC9.0000000000000273","article-title":"Serological response and breakthrough infection after COVID-19 vaccination in patients with cirrhosis and post-liver transplant","volume":"7","author":"Mehta","year":"2023","journal-title":"Hepatol. Commun."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4999","DOI":"10.1080\/21645515.2021.1984133","article-title":"COVID-19 vaccination hesitancy and associated factors among solid organ transplant recipients in China","volume":"17","author":"Chen","year":"2021","journal-title":"Hum. Vaccine Immunother."},{"key":"ref_14","unstructured":"World Health Organization (2025, February 19). Ten Threats to Global Health in 2019. Available online: https:\/\/www.who.int\/news-room\/spotlight\/ten-threats-to-global-health-in-2019."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1038\/s41541-024-00951-8","article-title":"COVID-19 vaccine refusal is driven by deliberate ignorance and cognitive distortions","volume":"9","author":"Hertwig","year":"2024","journal-title":"npj Vaccines"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Costantino, A., Morlacchi, L., Donato, M.F., Gramegna, A., Farina, E., Dibenedetto, C., Campise, M., Redaelli, M., Perego, M., and Alfieri, C. (2022). Hesitancy toward the Full COVID-19 Vaccination among Kidney, Liver and Lung Transplant Recipients in Italy. Vaccines, 10.","DOI":"10.3390\/vaccines10111899"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Fern\u00e1ndez, C.F., Torr\u00f3n, B.O., de Quir\u00f3s Fern\u00e1ndez, M.B., Garrido, R.S.J., Arroba, C.M.-A., Alonso, I.J., Quinto, A.A.M., Maestro, \u00d3.C., Molero, F.C., and Nutu, O.A. (2025). The Impact and Evolution of COVID-19 on Liver Transplant Recipients Throughout the Pandemic \u201cWaves\u201d in a Single Center. Viruses, 17.","DOI":"10.3390\/v17020273"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Rendina, M., Barone, M., Lillo, C., Trapani, S., Masiero, L., Trerotoli, P., Puoti, F., Lupo, L.G., Tandoi, F., and Agnes, S. (2023). The Italian data on SARS-CoV-2 infection in transplanted patients support an organ specific immune response in liver recipients. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1203854"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2558","DOI":"10.1016\/j.cgh.2022.06.028","article-title":"Humoral and Cellular Immune Response After Third and Fourth SARS-CoV-2 mRNA Vaccination in Liver Transplant Recipients","volume":"20","author":"Harberts","year":"2022","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1186\/s12985-024-02531-7","article-title":"Clinical outcomes of Omicron infection and vaccine acceptance among pediatric liver transplant recipients: Insights from a cross-sectional survey","volume":"21","author":"Zheng","year":"2024","journal-title":"Virol. J."}],"container-title":["Vaccines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/5\/455\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:21:01Z","timestamp":1760030461000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-393X\/13\/5\/455"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,24]]},"references-count":20,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["vaccines13050455"],"URL":"https:\/\/doi.org\/10.3390\/vaccines13050455","relation":{},"ISSN":["2076-393X"],"issn-type":[{"value":"2076-393X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,24]]}}}