Safety and Efficacy of SARS-CoV-2 Vaccines in Patients With Chronic Liver Diseases: A Systematic Review and Meta-Analysis.

Objectives: This review aimed to assess the safety and efficacy of SARS-CoV-2 vaccines in patients with chronic liver disease (CLD).

Methods: Cochrane Central Register of Controlled Trials, PubMed, Embase, and Web of Science were searched from 2020 to 2024. Data was extracted following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. The random-effects model (when I ≥ 50%) or fixed effect model (I < 50%) was used.

Results: 29 studies were included in this review. Compared to healthy controls (HCs), patients with CLD had a higher incidence of mild adverse events (RR = 1.60, < 0.001), while the incidence of severe adverse events was similar (RR = 1.08, = 0.92). Seropositivity rates of three antibodies in patients were lower than in HCs [neutralizing antibody (RR = 0.86, = 0.002), anti-spike antibody (RR = 0.97, = 0.06) and anti-receptor binding domain antibody (RR = 0.95, = 0.04)]. Compared to unvaccinated patients, vaccinated patients had lower rates of SARS-CoV-2 infection, hospitalization and death ( ≤ 0.05).

Conclusion: SARS-CoV-2 vaccines showed good safety and efficacy in CLD patients, but antibody response appeared to be decreased. Therefore, SARS-CoV-2 vaccines and booster doses should be given priority in this vulnerable population.