From the Guidelines
Shingles vaccination with RZV may be considered for liver transplant recipients, and the interval between transplant and vaccination depends on the regimen of immunosuppressants given and the clinical condition. The guidance for herpes zoster vaccination for adults, as outlined in a 2024 study published in the Journal of Microbiology, Immunology and Infection 1, suggests that the timing of vaccination for recipients of solid organ transplants (SOT) other than the kidney, such as liver transplant recipients, should be determined based on individual factors.
When considering vaccination, the preferred vaccine is the recombinant zoster vaccine (RZV), which is recommended over live zoster vaccines due to the immunocompromised state of transplant recipients. The complete regimen typically consists of two doses given 2-6 months apart. It's crucial for liver transplant recipients to consult with their transplant team before vaccination to ensure their immunosuppression levels are appropriate and to coordinate the timing with other medications and vaccines.
Key considerations for vaccination include:
- The risk of shingles and its complications, such as postherpetic neuralgia, which is higher in immunosuppressed patients
- The potential side effects of the vaccine, which are generally mild and may include pain at the injection site, fatigue, and muscle aches
- The importance of stabilizing immunosuppression before vaccination to maximize the vaccine's effectiveness and minimize risks.
Given the specific guidance for kidney transplantation, where vaccination with RZV may be considered at least 4 months post-transplantation 1, and the lack of specific recommendations for liver transplant recipients in the provided evidence, a cautious approach would be to consider vaccination at a similar or slightly longer interval post-transplantation, taking into account the individual's clinical condition and immunosuppressive regimen.
From the Research
Shingle Vaccination Post Liver Transplant
- The recombinant zoster vaccine (RZV) is a potential candidate to provide durable prevention of herpes zoster in solid organ transplant recipients, including liver transplant patients 2.
- Studies have shown that RZV is well tolerated and efficacious in preventing herpes zoster in immunocompromised individuals, including transplant recipients 3.
- The vaccine has been found to reduce the incidence of herpes zoster by 81% in immunocompromised adults, including those with a history of transplantation 3.
- However, data on the optimal timing of vaccination and durability of responses in liver transplant recipients are sparse 2.
- Expert recommendations suggest that liver transplant recipients should receive the RZV vaccine, preferably before transplantation or at least 2-3 months prior to immunosuppressive therapy 4, 5.
- The vaccine has been found to be safe and effective in preventing herpes zoster and related complications in immunocompetent adults aged 50 years and older, and its use is recommended in special populations, including immunocompromised individuals 6.
Considerations for Liver Transplant Recipients
- Liver transplant recipients are at a higher risk of developing herpes zoster and its complications due to immunosuppression 5.
- The crude incidence rate of herpes zoster infections in liver transplant recipients has been found to be 3.9% 5.
- Postherpetic neuralgia, a common complication of herpes zoster, has been found to be significantly higher in liver transplant recipients older than 45 years 5.
- Early specific and supportive treatment is important for liver transplant recipients with herpes zoster infections, and appropriate antiviral prophylaxis regimens and vaccination strategies should be implemented to prevent herpes zoster infections and complications 5.