In advanced stages of the disease, liver cirrhosis is considered a systemic disease as its complications manifest on various organs and impact several body functions. One such manifestation is the development of cirrhosis-associated immune dysfunction (CAID). The term CAID covers a variety of immune impairments involving alterations in both the innate and adaptive arm of the immune system, as well as chronic inflammation1 and results in increased susceptibility to infections, impaired tumour surveillance and hyporesponsiveness to vaccines.

The degree to which patients with cirrhosis develop protective immune responses to standard vaccinations varies greatly and challenges clinicians to design individualised vaccination schemes based on disease characteristics that yet need to be defined. While it has been well documented that patients with more advanced cirrhosis are less likely to develop protective immune responses to vaccines,2 it is unclear to what extent repeated exposure to a vaccine can improve responsiveness.

In Gut, Giráldez-Gallego et al have tackled this question by setting up an open-label randomised trial of two different hepatitis B virus (HBV) revaccination schemes in patients with cirrhosis who failed an initial three-dose HBV vaccination scheme.3 The final cohort exists of 120 patients including 72.5% of patients with decompensated or 55% of patients with Child-Pugh …