*Purpose: Infectious diseases are a leading cause of morbidity and mortality among patients with end-stage liver disease (ESLD). Vaccination data of ESLD patients pre- and post-transplantation is scarce. This study was created to evaluate the impact of pharmacist intervention on vaccination rates within the ESLD population.

*Methods: This study was a retrospective, quasi-experiment evaluating the impact of a pharmacist driven immunization clinic at a large academic medical center established in February 2018. Patients listed for liver transplant between August 2016 and July 2019 were separated into pre- and post-implementation cohorts based on timing of immunization clinic implementation. All patients in the post-implementation group were evaluated by pharmacist for need of hepatitis A, hepatitis B, and pneumococcal conjugate and polysaccharide vaccines according to Advisory Committee on Immunization Practices recommendations; if needed, vaccines were offered at future visits.

*Results: A total of 240 patients were included with 120 in each group. Demographics are reported in table 1. Vaccine series initiation rate prior to transplantation was higher in the post-implementation group: 54.9% vs. 15.6%; p<0.001. When evaluating each vaccine series separately, significantly more patients received hepatitis B (41.7 vs. 12.6%, p<0.001) and pneumococcal conjugate vaccination (26.9 vs. 14.4%, p=0.046) in the post-implementation group as compared to the pre-implementation group. The percentage of patients receiving hepatitis A (27.8 vs. 17.1%) and pneumococcal polysaccharide vaccination (30.6 vs. 18.9%) were higher in the post-implementation group, but not statistically significant. Additionally, a higher percentage of patients in the post-implementation group were considered to be up-to-date on their vaccines at end of follow up (31.4 vs. 9%, p<0.001).

*Conclusions: The pharmacist-driven immunization clinic significantly increased the incidence of vaccine series initiation in ESLD patients, as well as more patients were considered up-to-date at end of follow up. With appropriate vaccination, these patients are at a decreased risk of vaccine-preventable infections.

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