{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T14:52:23Z","timestamp":1780584743007,"version":"3.54.1"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T00:00:00Z","timestamp":1629936000000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,8,1]],"date-time":"2021-08-01T00:00:00Z","timestamp":1627776000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>The aim of this document is to provide a concise scientific review of the currently available COVID\u201019 vaccines and those in development, including mRNA, adenoviral vectors, and recombinant protein approaches. The anticipated use of COVID\u201019 vaccines in patients with chronic liver disease (CLD) and liver transplant (LT) recipients is reviewed and practical guidance is provided for health care providers involved in the care of patients with liver disease and LT about vaccine prioritization and administration. The Pfizer and Moderna mRNA COVID\u201019 vaccines are associated with a 94%\u201095% vaccine efficacy compared to placebo against COVID\u201019. Local site reactions of pain and tenderness were reported in 70%\u201090% of clinical trial participants, and systemic reactions of fever and fatigue were reported in 40%\u201070% of participants, but these reactions were generally mild and self\u2010limited and occurred more frequently in younger persons. Severe hypersensitivity reactions related to the mRNA COVID\u201019 vaccines are rare and more commonly observed in women and persons with a history of previous drug reactions for unclear reasons. Because patients with advanced liver disease and immunosuppressed patients were excluded from the vaccine licensing trials, additional data regarding the safety and efficacy of COVID\u201019 vaccines are eagerly awaited in these and other subgroups. Remarkably safe and highly effective mRNA COVID\u201019 vaccines are now available for widespread use and should be given to all adult patients with CLD and LT recipients. The online companion document located at https:\/\/www.aasld.org\/about\u2010aasld\/covid\u201019\u2010resources will be updated as additional data become available regarding the safety and efficacy of\u00a0other COVID\u201019 vaccines in development.<\/jats:p>","DOI":"10.1002\/hep.31751","type":"journal-article","created":{"date-parts":[[2021,2,14]],"date-time":"2021-02-14T09:27:36Z","timestamp":1613294856000},"page":"1049-1064","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":123,"title":["American Association for the Study of Liver Diseases Expert Panel Consensus Statement: Vaccines to Prevent Coronavirus Disease 2019 Infection in Patients With Liver Disease"],"prefix":"10.1097","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8570-9646","authenticated-orcid":false,"given":"Oren K.","family":"Fix","sequence":"first","affiliation":[{"name":"Elson S. Floyd College of Medicine,Washington State University,Spokane,WA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily A.","family":"Blumberg","sequence":"additional","affiliation":[{"name":"University of Pennsylvania,Philadelphia,PA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyong\u2010Mi","family":"Chang","sequence":"additional","affiliation":[{"name":"University of Pennsylvania,Philadelphia,PA,USA"},{"name":"The Corporal Michael J. Crescenz VA Medical Center,Philadelphia,PA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Chu","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai,New York,NY,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond T.","family":"Chung","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital,Boston,MA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth K.","family":"Goacher","sequence":"additional","affiliation":[{"name":"Duke University,Durham,NC,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bilal","family":"Hameed","sequence":"additional","affiliation":[{"name":"University of California,San Francisco,CA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel R.","family":"Kaul","sequence":"additional","affiliation":[{"name":"University of Michigan,Ann Arbor,MI,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura M.","family":"Kulik","sequence":"additional","affiliation":[{"name":"Northwestern Medicine,Chicago,IL,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan M.","family":"Kwok","sequence":"additional","affiliation":[{"name":"Uniformed Services University,Bethesda,MD,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan M.","family":"McGuire","sequence":"additional","affiliation":[{"name":"University of Alabama,Birmingham,AL,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0901-2617","authenticated-orcid":false,"given":"David C.","family":"Mulligan","sequence":"additional","affiliation":[{"name":"Yale University,New Haven,CT,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer C.","family":"Price","sequence":"additional","affiliation":[{"name":"University of California,San Francisco,CA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy S.","family":"Reau","sequence":"additional","affiliation":[{"name":"Rush University,Chicago,IL,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Rajender","family":"Reddy","sequence":"additional","affiliation":[{"name":"University of Pennsylvania,Philadelphia,PA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Reynolds","sequence":"additional","affiliation":[{"name":"San Francisco AIDS Foundation,San Francisco,CA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1110-6914","authenticated-orcid":false,"given":"Hugo R.","family":"Rosen","sequence":"additional","affiliation":[{"name":"Keck Medicine of USC,Los Angeles,CA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark W.","family":"Russo","sequence":"additional","affiliation":[{"name":"Atrium Health,Carolinas Medical Center,Charlotte,NC,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"Schilsky","sequence":"additional","affiliation":[{"name":"Yale University,New Haven,CT,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth C.","family":"Verna","sequence":"additional","affiliation":[{"name":"Columbia University,New York,NY,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W.","family":"Ward","sequence":"additional","affiliation":[{"name":"Coalition for Global Hepatitis Elimination,Decatur,GA,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Fontana","sequence":"additional","affiliation":[{"name":"University of Michigan,Ann Arbor,MI,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the AASLD COVID\u201019 Vaccine Working Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,8,26]]},"reference":[{"key":"hep31751-bib-0001-20250824","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1016\/j.cgh.2011.02.031","article-title":"Immune dysfunction and infections in patients with cirrhosis","volume":"9","year":"2011","journal-title":"Clin Gastroenterol Hepatol"},{"key":"hep31751-bib-0002-20250824","article-title":"Risk factors for severe outcomes following 2009 influenza A (H1N1) infection: a global pooled analysis","volume":"8","year":"2011","journal-title":"PLoS Med"},{"key":"hep31751-bib-0003-20250824","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.jinf.2012.02.017","article-title":"The effect of underlying clinical conditions on the risk of developing invasive pneumococcal disease in England","volume":"65","year":"2012","journal-title":"J Infect"},{"key":"hep31751-bib-0004-20250824","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1016\/j.transproceed.2012.05.071","article-title":"Response to vaccination against hepatitis B virus with a schedule of four 40\u2010\u03bcg doses in cirrhotic patients evaluated for liver transplantation: factors associated with a response","volume":"44","year":"2012","journal-title":"Transplant Proc"},{"key":"hep31751-bib-0005-20250824","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1590\/S1413-86702008000400009","article-title":"Double\u2010dose hepatitis B vaccination in cirrhotic patients on a liver transplant waiting list","volume":"12","year":"2008","journal-title":"Braz J Infect Dis"},{"key":"hep31751-bib-0007-20250824","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.3390\/v4061011","article-title":"Mechanisms of coronavirus cell entry mediated by the viral spike protein","volume":"4","year":"2012","journal-title":"Viruses"},{"key":"hep31751-bib-0008-20250824","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1038\/s41586-020-2008-3","article-title":"A new coronavirus associated with human respiratory disease in China","volume":"579","year":"2020","journal-title":"Nature"},{"key":"hep31751-bib-0010-20250824","first-page":"1920","article-title":"An mRNA vaccine against SARS\u2010CoV\u20102\u2014preliminary report","volume":"12","year":"2020","journal-title":"N Engl J Med"},{"key":"hep31751-bib-0011-20250824","first-page":"2603","article-title":"Safety and efficacy of the BNT162b2 mRNA Covid\u201019 vaccine","volume":"31","year":"2020","journal-title":"N Engl J Med"},{"key":"hep31751-bib-0012-20250824","first-page":"1571","article-title":"Nucleoside\u2010modified mRNA vaccines induce potent T follicular helper and germinal center B cell responses","volume":"4","year":"2018","journal-title":"J Exp Med"},{"key":"hep31751-bib-0013-20250824","doi-asserted-by":"crossref","first-page":"319","DOI":"10.4155\/tde-2016-0006","article-title":"mRNA vaccine delivery using lipid nanoparticles","volume":"7","year":"2016","journal-title":"Ther Deliv"},{"key":"hep31751-bib-0014-20250824","first-page":"65","article-title":"Nanomaterial delivery systems for mRNA vaccines","volume":"19","year":"2021","journal-title":"Vaccines (Basel)"},{"key":"hep31751-bib-0015-20250824","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1002\/hep.28294","article-title":"Chronic hepatitis C viral infection subverts vaccine\u2010induced T\u2010cell immunity in humans","volume":"63","year":"2016","journal-title":"Hepatology"},{"key":"hep31751-bib-0016-20250824","first-page":"27","article-title":"Highly\u2010immunogenic virally\u2010vectored T\u2010cell vaccines cannot overcome subversion of the T\u2010cell response by HCV during chronic infection","volume":"2","year":"2016","journal-title":"Vaccines (Basel)"},{"key":"hep31751-bib-0017-20250824","first-page":"99","article-title":"Safety and efficacy of the ChAdOx1 nCoV\u201019 vaccine (AZD1222) against SARS\u2010CoV\u20102: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK","volume":"9","year":"2021","journal-title":"Lancet"},{"key":"hep31751-bib-0020-20250824","first-page":"1845","article-title":"Safety, tolerability, and immunogenicity of a recombinant adenovirus type\u20105 vectored COVID\u201019 vaccine: a dose\u2010escalation, open\u2010label, non\u2010randomised, first\u2010in\u2010human trial","volume":"13","year":"2020","journal-title":"Lancet"},{"key":"hep31751-bib-0021-20250824","first-page":"3695","article-title":"Augmentation of vaccine\u2010induced humoral and cellular immunity by a physical radiofrequency adjuvant","volume":"12","year":"2018","journal-title":"Nat Commun"},{"key":"hep31751-bib-0025-20250824","doi-asserted-by":"crossref","first-page":"46\u2010","DOI":"10.15585\/mmwr.mm7002e1","article-title":"Allergic reactions including anaphylaxis after receipt of the first dose of Pfizer\u2010BioNTech COVID\u201019 vaccine\u2014United States, December 14\u201023, 2020","volume":"70","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"hep31751-bib-0026-20250824","doi-asserted-by":"crossref","first-page":"125","DOI":"10.15585\/mmwr.mm7004e1","article-title":"Allergic reactions including anaphylaxis after receipt of the first dose of Moderna COVID\u201019 vaccine\u2014United States, December 21, 2020\u2013January 10, 2021","volume":"70","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"hep31751-bib-0027-20250824","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1056\/NEJMra2035343","article-title":"Maintaining safety with SARS\u2010CoV\u20102 vaccines.","volume":"384","year":"2021","journal-title":"N Engl J Med"},{"key":"hep31751-bib-0028-20250824","article-title":"Transmission of SARS\u2010CoV\u20102 lineage B.1.1.7 in England: insights from linking epidemiological and genetic data","year":"2021","journal-title":"MedRxiv"},{"key":"hep31751-bib-0029-20250824","article-title":"Emergence and rapid spread of a new severe acute respiratory syndrome\u2010related coronavirus 2 (SARS\u2010CoV\u20102) lineage with multiple spike mutations in South Africa","year":"2020","journal-title":"MedRxiv"},{"key":"hep31751-bib-0030-20250824","article-title":"Genomic characterisation of an emergent SARS\u2010CoV\u20102 lineage in Manaus: preliminary findings\u2014SARS\u2010CoV\u20102 coronavirus \/ nCoV\u20102019 Genomic Epidemiology","year":"2021","journal-title":"Virological"},{"key":"hep31751-bib-0031-20250824","doi-asserted-by":"crossref","first-page":"95\u2010","DOI":"10.15585\/mmwr.mm7003e2","article-title":"Emergence of SARS\u2010CoV\u20102 B.1.1.7 lineage\u2014United States, December 29, 2020\u2010January 12, 2021","volume":"70","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"hep31751-bib-0032-20250824","article-title":"Coronavirus: UK variant \u2018may be more deadly.\u2019","year":"2021","journal-title":"BBC News"},{"key":"hep31751-bib-0033-20250824","article-title":"Neutralization of N501Y mutant SARS\u2010CoV\u20102 by BNT162b2 vaccine\u2010elicited sera","year":"2021","journal-title":"BioRxiv"},{"key":"hep31751-bib-0034-20250824","article-title":"Neutralization of SARS\u2010CoV\u20102 lineage B.1.1.7 pseudovirus by BNT162b2 vaccine\u2010elicited human sera","year":"2021","journal-title":"BioRxiv"},{"key":"hep31751-bib-0035-20250824","article-title":"mRNA\u20101273 vaccine induces neutralizing antibodies against spike mutants from global SARS\u2010CoV\u20102 variants","year":"2021","journal-title":"BioRxiv"},{"key":"hep31751-bib-0036-20250824","first-page":"334","article-title":"Multisystem inflammatory syndrome in U.S. children and adolescents","volume":"23","year":"2020","journal-title":"N Engl J Med"},{"key":"hep31751-bib-0037-20250824","article-title":"Impact of COVID\u201019 pandemic on pediatrics and pediatric transplantation programs","volume":"8","year":"2020","journal-title":"Front Pediatr"},{"key":"hep31751-bib-0041-20250824","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1016\/j.jhep.2020.06.001","article-title":"High rates of 30\u2010day mortality in patients with cirrhosis and COVID\u201019","volume":"73","year":"2020","journal-title":"J Hepatol"},{"key":"hep31751-bib-0042-20250824","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1038\/s41586-020-2521-4","article-title":"Factors associated with COVID\u201019\u2010related death using OpenSAFELY","volume":"584","year":"2020","journal-title":"Nature"},{"key":"hep31751-bib-0043-20250824","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1016\/j.jhep.2020.05.013","article-title":"High mortality rates for SARS\u2010CoV\u20102 infection in patients with pre\u2010existing chronic liver disease and cirrhosis: preliminary results from an international registry","volume":"73","year":"2020","journal-title":"J Hepatol"},{"key":"hep31751-bib-0044-20250824","first-page":"768","article-title":"Clinical characteristics and outcomes of COVID\u201019 among patients with pre\u2010existing liver disease in United States: a multi\u2010center research network study","volume":"159","year":"2020","journal-title":"Gastroenterology"},{"key":"hep31751-bib-0045-20250824","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1136\/gutjnl-2020-322118","article-title":"Comparison of mortality risk in patients with cirrhosis and COVID\u201019 compared with patients with cirrhosis alone and COVID\u201019 alone: multicentre matched cohort","volume":"70","year":"2021","journal-title":"Gut"},{"key":"hep31751-bib-0046-20250824","article-title":"Robust spike antibody responses and increased reactogenicity in seropositive individuals after a single dose of SARS\u2010CoV\u20102 mRNA vaccine","year":"2021","journal-title":"MedRxiv"},{"key":"hep31751-bib-0048-20250824","first-page":"1257","article-title":"Coronavirus Disease 2019 (COVID\u201019) in autoimmune hepatitis: a lesson from immunosuppressed patients","volume":"9","year":"2020","journal-title":"Hepatol Commun"},{"key":"hep31751-bib-0049-20250824","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.jhep.2020.07.040","article-title":"Epidemiological pattern, incidence and outcomes of COVID\u201019 in liver transplant patients","volume":"74","year":"2021","journal-title":"J Hepatol"},{"key":"hep31751-bib-0050-20250824","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1016\/S2468-1253(20)30271-5","article-title":"Outcomes following SARS\u2010CoV\u20102 infection in liver transplant recipients: an international registry study","volume":"5","year":"2020","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"hep31751-bib-0051-20250824","article-title":"SARS\u2010CoV\u20102 vaccination in patients with liver disease: responding to the next big question","year":"2021","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"hep31751-bib-0052-20250824","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1016\/j.cgh.2013.06.006","article-title":"Hepatitis B and C in African Americans: current status and continued challenges","volume":"12","year":"2014","journal-title":"Clin Gastroenterol Hepatol"},{"key":"hep31751-bib-0053-20250824","first-page":"1175","article-title":"Nonalcoholic steatohepatitis: a review","volume":"24","year":"2020","journal-title":"JAMA"},{"key":"hep31751-bib-0054-20250824","first-page":"263","article-title":"Hepatitis B vaccination. Response of alcoholic with and without liver injury","volume":"33","year":"1988","journal-title":"Dig Dis Sci"},{"key":"hep31751-bib-0055-20250824","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1111\/j.1572-0241.1999.01150.x","article-title":"Immunogenicity of hepatitis A vaccine in decompensated liver disease","volume":"94","year":"1999","journal-title":"Am J Gastroenterol"},{"key":"hep31751-bib-0056-20250824","first-page":"1590","article-title":"Failure of hepatitis B immunization in liver transplant recipients: results of a prospective trial","volume":"85","year":"1990","journal-title":"Am J Gastroenterol"},{"key":"hep31751-bib-0057-20250824","first-page":"403","article-title":"Efficacy and safety of the mRNA\u20101273 SARS\u2010CoV\u20102 vaccine","volume":"4","year":"2021","journal-title":"N Engl J Med"},{"key":"hep31751-bib-0058-20250824","article-title":"Interim results of a phase 1\u20102a trial of Ad26.COV2.S Covid\u201019 vaccine","year":"2021","journal-title":"N Engl J Med"},{"key":"hep31751-bib-0059-20250824","first-page":"479","article-title":"Immunogenicity and safety of a recombinant adenovirus type\u20105\u2010vectored COVID\u201019 vaccine in healthy adults aged 18 years or older: a randomised, double\u2010blind, placebo\u2010controlled, phase 2 trial","volume":"15","year":"2020","journal-title":"Lancet"},{"key":"hep31751-bib-0060-20250824","article-title":"New Brazil data shows disappointing 50.4% efficacy for China\u2019s CoronaVac vaccine","journal-title":"Reuters"},{"key":"hep31751-bib-0061-20250824","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/S1473-3099(20)30831-8","article-title":"Safety and immunogenicity of an inactivated SARS\u2010CoV\u20102 vaccine, BBIBP\u2010CorV: a randomised, double\u2010blind, placebo\u2010controlled, phase 1\/2 trial","volume":"21","year":"2021","journal-title":"Lancet Infect Dis"}],"container-title":["Hepatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hep.31751","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hep.31751","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/10.1002\/hep.31751","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T23:10:42Z","timestamp":1756077042000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1002\/hep.31751"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":50,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.1002\/hep.31751","relation":{},"ISSN":["0270-9139","1527-3350"],"issn-type":[{"value":"0270-9139","type":"print"},{"value":"1527-3350","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8]]},"assertion":[{"value":"2021-02-07","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-02-08","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}