Vaccination in adult liver transplantation candidates and recipients

Clin Res Hepatol Gastroenterol. 2020 Apr;44(2):126-134. doi: 10.1016/j.clinre.2019.08.007. Epub 2019 Oct 10.


In patients with chronic liver disease and liver transplant recipients, cirrhosis-associated immune dysfunction syndrome and immunosuppressant drug regimens required to prevent graft rejection lead to a high risk of severe infections, associated with acute liver decompensation, graft loss and increased mortality. In addition to maintain their global health status, vaccination represents a major preventive measure against specific infectious risks of particular concern in this population, such as invasive pneumococcal diseases, influenza or viral hepatitis A and B. However, immunization in this setting raises several issues: i) recommended vaccination schedules rely on sparse immunogenicity data without clinical efficacy and effectiveness trials designed for this specific population; ii) dynamics of immunosuppression makes timing of immunization challenging; iii) live attenuated vaccines are contraindicated after transplantation; and iv) vaccines tolerance is poorly known in cirrhotic patients. This review outlines the rational for vaccination in adult liver transplant candidates and recipients and available data regarding immunization in this specific population.

Keywords: Influenza; Invasive pneumococcal disease; Liver transplantation; Vaccination; Viral hepatitis A; Viral hepatitis B.

Publication types

  • Review

MeSH terms

  • Bacterial Infections / prevention & control*
  • Humans
  • Liver Transplantation*
  • Postoperative Complications / microbiology*
  • Postoperative Complications / prevention & control*
  • Practice Guidelines as Topic
  • Vaccination*
  • Virus Diseases / prevention & control*