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People with decompensated cirrhosis should be prioritised for COVID-19 vaccination and immunosuppressive treatment after a liver transplant should not be a barrier to vaccination, an international panel of liver experts has concluded.
Their review of the available evidence is published in the journal The Lancet Gastroenterology and Hepatology.
They point out that the evidence on vaccine efficacy in people with chronic liver disease or post-transplant immunosuppression is very limited.
People with liver disease were included in the trials of the Pfizer and Moderna mRNA vaccines but excluded from the trials of the Oxford/AstraZeneca vaccine. People receiving immunosuppressive treatment after a liver transplant were excluded from trials of all three vaccines, as were people with autoimmune liver disease.
The review does not discuss the vaccine developed by the Chinese manufacturer Sinopharm, already in use in China, or the Russian Sputnik vaccine.
The experts warn that vaccine responses will need to be monitored in people with liver disease, as some liver conditions can weaken vaccine responses.
People with cirrhosis are less likely to produce antibodies after hepatitis B vaccination and have less durable responses to flu vaccine. Similarly, people receiving immunosuppressive medication for liver transplantation have weaker antibody responses to flu and hepatitis B vaccinations.
People with decompensated cirrhosis must be a high priority group for vaccination, say the experts, due to their higher risk of death from COVID-19.
Although vaccinations are usually recommended prior to liver transplantation or after the transplant recipient has been stabilised on maintenance immunosuppressive treatment, the experts say that COVID-19 vaccination should not be delayed in liver transplant patients.
In the United Kingdom, the Joint Council on Vaccination and Immunisation has decided that people over 65 will be prioritised for vaccination, ahead of younger people with underlying health conditions including chronic liver disease.
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