Vaccination in liver diseases and liver Transplantation: Recommendations, implications and opportunities in the post-covid era

Abstract

The interest in vaccination efficacy and toxicity has surged following the Covid-19 pandemic. Immune responses to several vaccines have been shown to be suboptimal in patients with chronic liver disease (CLD) or post-liver transplant (LT), as a consequence of cirrhosis-associated immune dysfunction (CAID) or post-LT immunosuppression respectively. Accordingly, vaccine-preventable infections may be more common or severe than in the general population. The Covid-19 pandemic has greatly accelerated research and development into vaccination technology and platforms, which will have spillover benefits for liver patients. The aims of this review are: (i) to discuss the impact of vaccine-preventable infections on CLD and post-LT patients, (ii) to appraise current evidence supporting vaccination strategies, and (iii) to provide some insight into recent developments relevant for liver patients.

Keywords: Cirrhosis; Covid-19; Hepatitis; Liver transplant; Vaccination.

Fig. 1

Overview of vaccination in cirrhosis focused on future developments: Vaccination technology and platforms. Vaccine responses in cirrhosis are reduced as a consequence of cirrhosis-associated immune dysfunction; moreover, the consequences of infection are greater in these patients with higher rates of organ failure and mortality. Several advances in vaccine therapeutics may positively influence outcomes in patients with cirrhosis, such as: personalised vaccine therapy using systems biology approaches, novel vaccine platforms (e.g. mRNA technology), greater understanding of vaccine adjuvants, and modulation of inflammatory response (e.g. albumin or gut microbiome-directed therapeutics).