Serological response and breakthrough infection after COVID-19 vaccination in patients with cirrhosis and post-liver transplant

Background: Vaccine hesitancy and lack of access remain major issues in disseminating COVID-19 vaccination to liver patients globally. Factors predicting poor response to vaccination and risk of breakthrough infection are important data to target booster vaccine programs. The primary aim of the current study was to measure humoral responses to 2 doses of COVID-19 vaccine. Secondary aims included the determination of factors predicting breakthrough infection.Methods: COVID-19 vaccination and Biomarkers in cirrhosis And post-Liver Transplantation is a prospective, multicenter, observational case-control study. Participants were recruited at 4–10 weeks following first and second vaccine doses in cirrhosis [n = 325; 94% messenger RNA (mRNA) and 6% viral vaccine], autoimmune liver disease (AILD) (n = 120; 77% mRNA and 23% viral vaccine), post-liver transplant (LT) (n = 146; 96% mRNA and 3% viral vaccine), and healthy controls (n = 51; 72% mRNA, 24% viral and 4% heterologous combination). Serological end points were measured, and data regarding breakthrough SARS-CoV-2 infection were collected.Results: After adjusting by age, sex, and time of sample collection, anti-Spike IgG levels were the lowest in post-LT patients compared to cirrhosis (p < 0.0001), AILD (p < 0.0001), and control (p = 0.002). Factors predicting reduced responses included older age, Child-Turcotte-Pugh B/C, and elevated IL-6 in cirrhosis; non-mRNA vaccine in AILD; and coronary artery disease, use of mycophenolate and dysregulated B-call activating factor, and lymphotoxin-α levels in LT. Incident infection occurred in 6.6%, 10.6%, 7.4%, and 15.6% of cirrhosis, AILD, post-LT, and control, respectively. The only independent factor predicting infection in cirrhosis was low albumin level.Conclusions: LT patients present the lowest response to the SARS-CoV-2 vaccine. In cirrhosis, the reduced response is associated with older age, stage of liver disease and systemic inflammation, and breakthrough infection with low albumin level

Quelle due o tre tazze di t\ue8 verde: caso clinico.

Una signora si reca in Pronto soccorso per dolore epi-mesogastrico associato a nausea di cui soffre da qualche mese. Si riscontra un incremento delle ALT e un lieve aumento della bilirubina totale. La donna nega l\u2019assunzione recente e/o continua di farmaci, ma dichiara l\u2019assunzione quotidiana di due o tre tazze di infusi di t\ue8 verde. Gli esami sierologici risultano negativi e l\u2019analisi istologica documenta un danno \u201ctossico\u201d da farmaci. Alla sospensione dell\u2019assunzione del t\ue8 verde, i parametrici epatici rientrano

Acute hepatitis caused by green tea infusion: a case report .

The consumption of tea originated in Asia thousands of years ago and was introduced progressively all around the world. In the literature there are some reports of adverse hepatic reaction associated to green tea. We describe and discuss a case of acute hepatitis caused by the use of green tea infusion