Abstract
Background
Liver transplant (LT) recipients may experience substantial clinical and psychosocial vulnerability during infectious disease outbreaks because of lifelong immunosuppression. This study evaluated COVID-19 vaccination uptake, vaccine acceptance and hesitancy, preventive behavior, risk perception, and psychosocial well-being among LT recipients.
Methods
This cross-sectional analytical study included 311 adult LT recipients followed at a tertiary liver transplantation institute in Türkiye. Data were collected through structured face-to-face interviews using a standardized questionnaire and three validated instruments: the Short Depression–Happiness Scale (SDHS), COVID-19 Prevention Guidelines Compliance Scale (COVID-PGCS), and COVID-19 Risk Perception Scale (COVID-RPS). Exploratory group comparisons, correlation analyses, and multivariable linear regression models were performed.
Results
COVID-19 vaccination uptake was 84.9%. The most frequently reported reasons for vaccination were recommendations from health professionals, perceived higher mortality among patients with chronic diseases, high vaccine effectiveness, and recommendations from health authorities. The leading reasons for vaccine hesitancy were insufficient evidence regarding vaccine effectiveness and safety, anti-vaccination messages on social media, and concerns about adverse effects. In multivariable analyses, higher SDHS scores were independently associated with middle income (
p
= 0.006), high income (
p
= 0.021), everolimus use (
p
= 0.041), and influence of scientific journals and official documents (
p
= 0.006), whereas COVID-19 infection after BNT162b2 vaccination was associated with lower SDHS scores (
p
= 0.004). The latter estimate should be interpreted cautiously because this subgroup included only seven recipients. No individual variable was independently associated with COVID-PGCS scores. In the full COVID-RPS model, middle income was independently associated with lower scores (
p
= 0.011), whereas motivation to protect parents and children was associated with higher scores (
p
= 0.040). COVID-19 vaccination status and the infection-timing categories were not statistically significant in the full model. Sensitivity analyses showed that vaccination status became significant when infection timing was excluded (
p
= 0.009), whereas infection before vaccination became significant when vaccination status was excluded (
p
= 0.006), indicating model-specification dependence.
Conclusion
COVID-19 vaccination uptake was high among LT recipients. Psychosocial well-being and risk perception were associated with selected socioeconomic, clinical, and informational factors, whereas no individual variable examined was independently associated with preventive compliance. Vaccination status and infection timing should not be interpreted as robust, mutually independent determinants of COVID-19 risk perception. These findings support reliable scientific communication, psychosocial support, and sustained engagement with transplant recipients during future infectious disease outbreaks.