Herpes Zoster (Shingles) is a major cause of pain and expense to the elderly and chronically ill. The incidence is estimated at 3 in 1,000 patients. Zostavax™ is a high dose, live varicella vaccine that has been validated in very large placebo control trials to reduce the incidence of Herpes Zoster rash and post herpetic neuralgia in patients over 50 years of age. Additionally the vaccine has been shown to increase quality of life in these patients. Symptomatic Herpes Zoster rates are particularly high post liver transplant with the 3-, 5-, and 10-year actuarial rates of Herpes Zoster of 3%, 10%, 14%, and 18%, respectively. Zostavax is currently recommended for patients prior to solid organ transplantation with no adult data in liver transplant candidates to support that practice. And Although cirrhosis has been acknowledged as a risk factor for symptomatic Herpes Zoster, there is no published data on the efficacy of Zostavax in chronically ill cirrhotic adults pre-transplantation. In particular, it is not known whether or not chronically ill cirrhotic patients demonstrate the appropriate age related cell-mediated immune response seen in the original Zostavax trials.