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

Table 5 Currently recommended hepatitis A virus and hepatitis B virus vaccines in patients with chronic liver disease and liver transplantation recipients

Vaccine (brand)	Recommended adult use	Clinical notes in CLD/LT
Hepatitis A
Havrix® (inactivated HAV)	2 doses: 0 and 6-12 months	Prefer pre-LT when feasible. Consider post-vaccination anti-HAV: Check ~1-2 months after dose 2; if anti-HAV < 20 mIU/mL, give an additional dose and recheck
Vaqta® (inactivated HAV)	2 doses: 0 and 6-18 months
Hepatitis B
Engerix-B® (recombinant HBsAg)	3 doses: 0, 1, 6 months	Consider double-dose 40 µg per dose and/or additional doses due to lower response. Prefer completion pre-LT; if post-LT, vaccinate once immunosuppression is stable. Check anti-HBs 1-2 months after last dose; if < 10 IU/L, revaccinate/boost
Recombivax HB® (recombinant HBsAg)	3 doses: 0, 1, 6 months
HBVaxPro® (recombinant HBsAg)	3 doses: 0, 1, 6 months
Fendrix® (HBsAg + adjuvant; “enhanced” vaccine)	4 doses: 0, 1, 2, 6 months	Often more immunogenic in poor responders. May be considered off-label for CLD/LT candidates depending on local policy
Heplisav-B® (CpG-adjuvanted; TLR9 agonist)	2 doses: 0, 1 month	Highly immunogenic and simplifies completion pre-LT. Availability varies by country/region
Hepatitis A and B combination
Twinrix® (HAV/HBV combination)	3 doses: 0, 1, 6 months (accelerated schedules exist)	Useful when both HAV and HBV vaccination are indicated

HAV: Hepatitis A virus; HBV: Hepatitis B virus; HBsAg: Hepatitis B surface antigen; CLD: Chronic liver disease; LT: Liver transplantation; Anti-HAV: Antibody to hepatitis A virus; Anti-HBs: Antibody to hepatitis B surface antigen; TLR9: Toll-like receptor 9.