Acute cellular rejection in liver transplantation recipients following coronavirus disease 2019 vaccination.

CONFLICT OF INTEREST

Nothing to report.

To the editor,

We would like to share ideas on the publication “Acute cellular rejection (ACR) in liver transplantation (LT) recipients following vaccination against coronavirus disease 2019: A case series.”[ ] Sarwar et al.[ ] noted that “we report a series of LT recipients who developed ACR following their COVID‐19 vaccinations. Our findings highlight the need for comprehensive postvaccination surveillance programs in patients where the high immunogenicity of the vaccines could potentially provoke adverse events. It is important to note that all episodes of ACR in our series were easily treated without any serious complications, and our preliminary findings should not be used to discourage vaccination for COVID‐19 in LT recipients.” We agree that coronavirus disease 2019 (COVID‐19) vaccination might cause a liver adverse effect. In the present report, vaccine recipients might have ACR but it might or might not be associated with COVID‐19 vaccination. The possibility of a concurrent medical problem that might lead to ACR should be discussed. For example, a vaccine recipient might acquire concurrent dengue infection.[ ] The acquired arbovirus disease in LT case is a rare clinical entity and usually underdiagnosed.[ ] This clinical problem might be a cause of ACR.[ ]