Not just another shot: Tailoring vaccination in the era of modern liver transplantation

Table 1 Characteristics of available pneumococcal vaccines

Vaccine (brand)	Serotypes covered	Recommended adult use	Clinical notes in CLD/LT
PPSV23 (Pneumovax 23®, Merck)	1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F, 33F	Adults ≥ 19 years with risk factors; given after PCV15 (≥ 1 year later; min 8 weeks if immunocompromised); not needed after PCV20/21	Broadest coverage but short-lived immunity and rapid titer decline post-LT. Used mainly to broaden coverage after conjugate vaccine
PCV13 (Prevnar 13®, Pfizer)	1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, 23F	Option if higher-valency PCVs unavailable	Early LT data showed better response than PPSV23, but immunity wanes quickly
PCV15 (Vaxneuvance®, Merck)	PCV13 + 22F, 33F	Adults ≥ 19 years: One dose, then PPSV23 ≥ 1 year later (min 8 weeks if immunocompromised)	Broader coverage and stronger immunogenicity than PCV13
PCV20 (Prevnar 20®, Pfizer)	PCV13 + 8, 10A, 11A, 12F, 15B, 22F, 33F	Adults ≥ 19 years: Single dose; no PPSV23 needed	Broadest coverage Preferred single-dose option for CLD/LT. Limited durability data post-LT
PCV21 (Capvaxive™, Merck)	PCV21 + 15A, 15C, 16F, 23A, 23B, 24F, 31, 35B

CLD: Chronic liver disease; LT: Liver transplantation.