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

Infections remain a leading cause of morbidity and mortality in patients with cirrhosis and liver transplantation (LT). Vaccination is underutilized despite proven benefits, and responses are often blunted by cirrhosis-associated immune dysfunction and post-transplant immunosuppression. This review synthesizes current evidence and recent advances in vaccination strategies for adult LT recipients, emphasizing optimal timing, novel vaccine platforms, and precision vaccinology. We discuss emerging data on coronavirus disease 2019, respiratory syncytial virus, and new pneumococcal and hepatitis B vaccines, highlight strategies to overcome immunogenicity gaps, and address implementation barriers. A practical roadmap and clinician-focused algorithms are proposed to integrate vaccination into the continuum of LT care.