Influenza vaccine induces stronger immune responses in liver cirrhosis patients

Seasonal influenza virus infections represent a global health threat, especially in high-risk groups, including patients with liver cirrhosis that are considered to be immunocompromised, in particular in decompensated stages. Although vaccination is the most cost-efficient tool to prevent infectious diseases, information about vaccine performance in these patients is scarce. This study aimed to dissect the immunological responses to seasonal influenza vaccines in patients suffering from compensated or decompensated liver cirrhosis. Prospective, observational studies during the influenza seasons 2019-2020 (1st season) and 2020-2021 (2nd season) were performed. Participants received the WHO recommended seasonal tetravalent inactivated influenza vaccine. Samples taken before and after vaccination were subjected to in-depth analyses by serology, cytokine immunoprofiling, multi-parametric flow cytometry, and metabolomics. Patients with liver cirrhosis showed stronger vaccine-induced immune responses in comparison to healthy individuals, including hemagglutination-inhibiting and neutralizing antibodies. Furthermore, enhanced cell-mediated immune responses were observed in the cirrhosis patients as compared to healthy subjects after vaccination. Surprisingly, vaccination response was even stronger in more advanced, decompensated stages of liver cirrhosis. Distinct serum cytokine and metabolite profiles associated with systemic inflammation differentiated patients with decompensated from compensated cirrhosis as well as from the healthy individuals and were linked to vaccine response. Patients with liver cirrhosis can mount an efficient response to seasonal influenza vaccines that is even superior in more advanced stages of cirrhosis. Systemic inflammation caused by liver cirrhosis may contribute to distinct humoral and cellular vaccine responses.