Table 4.
Vaccines recommendations in chronic liver disease and in liver transplant (LT) recipients.
| Pre-Transplant | Post-Transplant | |||
|---|---|---|---|---|
| Timing | Schedule | Timing | Schedule | |
| Influenza | Inactivated, at least 2 weeks prior LT | Single dose | Inactivated, 1 month after LT | Single dose |
| Streptococcus pneumoniae | At least 2 weeks prior LT | Not previously vaccinated: one dose of PCV 13 followed at least 8 weeks by one dose of PPV23. Vaccinated with PPV23: one dose of PCV 13 at least 1 year after PPV23 and one dose of PPV23 at least 5 years after the first dose |
3–6 months after LT | PCV13 followed by PPSV23 8 weeks later |
| HBV | At least 2 weeks prior LT | 0, 1 and 6 months | 3–6 months after LT | 0, 1 and 6 months |
| HAV | At least 2 weeks prior LT | Two doses six months apart or if combined with HBV vaccine 3 doses over a six months period | 3–6 months after LT | Two doses six months apart or if combined with HBV vaccine 3 doses over a six months period |
| SARS-CoV-2 | At least 2 weeks prior LT | As general population | 3–6 months after KT | As general population |
| HZV | At least 4 weeks pre-LT | Two LAV doses 4 weeks apart for varicella vaccine; one dose for zoster in HZV IgG positive candidates | Not recommended | - |
| Meningococcal, HPV | At least 2 weeks prior LT | As general population | 3–6 months after LT | As general population |
| MMR | At least 4 weeks pre-LT | As general population | 3–6 months after LT | As general population |
| Tetanus, Tdap/Td, Haemophilus influenza type B, Rabies | At least 2 weeks prior LT | As general population | 3–6 months after LT | As general population |
| Yellow fever | At least 4 weeks pre-LT | As general population | Not recommended | - |
| Polio | At least 4 weeks pre-LT | As general population | Inactivated, 3–6 months after LT | As general population |
| Rotavirus, BCG, Smallpox, Cholera | At least 4 weeks pre-LT | As general population | Not recommended | - |
LAVs, live attenuated vaccines; LZV, live attenuated zoster vaccine; PCV13, 13-valent pneumococcal conjugate vaccine; PPSV23, 23-valent pneumococcal polysaccharide vaccine; RZV, recombinant zoster vaccine; HAV, hepatitis A virus; HBV, hepatitis B; HPV, human papilloma virus; HZV, herpes zoster virus; MMR, measles mumps and rubella; Tdap, tetanus toxoid, reduced diphtheria toxoid, acellular pertussis; Td, tetanus diphtheria; BCG, bacille Calmette–Guerin.