Histologic Features of Liver Injury Associated With SARS-CoV-2 Messenger RNA Vaccines
Year: 2024
Type: article
Study design: Observational Study
Abstract: CONTEXT.—: Many drugs can induce liver injury; however, vaccine-induced liver injury is a rare phenomenon. SARS-CoV-2 messenger RNA (mRNA) vaccines are now widely administered, and clinical evidence of liver injury has been reported. OBJECTIVE.—: To characterize the histologic features of SARS-CoV-2 mRNA vaccine-associated liver injury. DESIGN.—: Thirteen liver biopsies from 12 patients with elevated liver enzymes clinically favored to be secondary to SARS-CoV-2 mRNA vaccine were identified between 2021 and 2022. Demographics, clinical information, and histologic features of liver biopsies were reviewed. RESULTS.—: All patients (median age, 58 years; M:F = 4:8) received at least 1 dose of SARS-CoV-2 mRNA vaccines (7 Pfizer and 5 Moderna). Four patients had a history of liver disease. Nine patients developed symptoms between 1 day and 2 months after receiving the vaccine dose. Viral serologies were negative. Drug-induced liver injury was thought to be less likely clinically in the 3 patients who had started new medications. Autoimmune antibodies were detected in 9 patients. Moderate to severe active hepatitis was the dominant histologic pattern of injury (9 of 13 biopsies; 69%). Resolving hepatitis, cholestatic hepatitic injury, and bile duct injury were identified in 1 biopsy each. All patients recovered spontaneously or with steroid therapy, except one patient who developed autoimmune hepatitis. CONCLUSIONS.—: Moderate to severe active hepatitis is commonly observed in SARS-CoV-2 mRNA vaccine-associated liver injury, and female patients may be more susceptible to injury. Liver injury resolves spontaneously or with steroid treatment. In rare cases, these vaccines may trigger an underlying immune condition.
Institutions: University Hospitals of Cleveland, University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center, Case Western Reserve University, Northwestern University, Emory University, Washington University in St. Louis, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, University of Alabama, University of Alabama at Birmingham, UAB Medicine, University of Michigan, Michigan Medicine
Language: English
Subfield: Pharmacology
Domain: Life Sciences
Open Access status: diamond
OpenAlex ID: W4402378455