Vaccination in liver diseases and liver transplantation: Recommendations, implications and opportunities in the post-COVID era

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) and liver transplant (LT) recipients, as a consequence of cirrhosis-associated immune dysfunction or post-LT immunosuppression, respectively. Accordingly, vaccine-preventable infections may be more common or severe in those with liver disease 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 patients with liver disease. The aims of this review are: (i) to discuss the impact of vaccine-preventable infections on patients with CLD and LT recipients, (ii) to appraise current evidence supporting vaccination strategies, and (iii) to provide some insight into recent developments relevant for patients with liver disease.