The issue

Patients with cirrhosis, acute-on-chronic liver failure (ACLF), and hepatocellular carcinoma appear to be at high risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and progress to most severe forms of COVID-19 with at least 5-fold increased risk of death. Patients with cirrhosis have been shown to have markedly worse outcomes from COVID-19. Moreover, there is very little data on the effectiveness of SARS-CoV-2 vaccines in cirrhosis or liver transplant patients since they were not included in initial clinical trials.

The approach

The aim of the COBALT study is to determine the protective effect of COVID-19 vaccination in liver disease. Patients with cirrhosis have been shown to have markedly worse outcomes from COVID-19. Moreover, there is very little data on the effectiveness of SARS-CoV-2 vaccines in cirrhosis or liver transplant patients since they were not included in initial clinical trials. We will compare responses after a 2-dose and 3-dose of the vaccine with healthy controls, to look at the level of antibody response. We will also investigate the durability of response and degree of protection against COVID-19.