Liver injury after SARS‐CoV‐2 vaccination: Features of immune‐mediated hepatitis, role of corticosteroid therapy and outcome
Year: 2022
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND AIMS: A few case reports of autoimmune hepatitis-like liver injury have been reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. We evaluated clinical features, treatment response and outcomes of liver injury following SARS-CoV-2 vaccination in a large case series. APPROACH AND RESULTS: We collected data from cases in 18 countries. The type of liver injury was assessed with the R-value. The study population was categorized according to features of immune-mediated hepatitis (positive autoantibodies and elevated immunoglobulin G levels) and corticosteroid therapy for the liver injury. We identified 87 patients (63%, female), median age 48 (range: 18-79) years at presentation. Liver injury was diagnosed a median 15 (range: 3-65) days after vaccination. Fifty-one cases (59%) were attributed to the Pfizer-BioNTech (BNT162b2) vaccine, 20 (23%) cases to the Oxford-AstraZeneca (ChAdOX1 nCoV-19) vaccine and 16 (18%) cases to the Moderna (mRNA-1273) vaccine. The liver injury was predominantly hepatocellular (84%) and 57% of patients showed features of immune-mediated hepatitis. Corticosteroids were given to 46 (53%) patients, more often for grade 3-4 liver injury than for grade 1-2 liver injury (88.9% vs. 43.5%, p = 0.001) and more often for patients with than without immune-mediated hepatitis (71.1% vs. 38.2%, p = 0.003). All patients showed resolution of liver injury except for one man (1.1%) who developed liver failure and underwent liver transplantation. Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution. None had a relapse during follow-up. CONCLUSIONS: SARS-CoV-2 vaccination can be associated with liver injury. Corticosteroid therapy may be beneficial in those with immune-mediated features or severe hepatitis. Outcome was generally favorable, but vaccine-associated liver injury led to fulminant liver failure in one patient.
Source: Hepatology
DOI: 10.1002/hep.32572
Authors: Cumali Efe, Anand V. Kulkarni, Benedetta Terziroli Beretta‐Piccoli, Bianca Magro, Albert Stättermayer, Mustafa Cengiz, Daniel Clayton‐Chubb, Craig Lammert, Christine Bernsmeier, Özlem Gül, Fatima Higuera‐de la Tijera, Margarita Anders, Ellina Lytvyak, Mete Akın, Tugrul Purnak, Rodrigo Liberal, Mirta Peralta, Berat Ebik, Serkan Duman, Nurhan Demir, Yasemin Balaban, Álvaro Urzua, Fernando Contreras, Maria Grazia Venturelli, Yılmaz Bilgiç, Adriana Medina, Marcos Girala, Fulya Günşar, Maria‐Carlota Londoño, Theodoros Androutsakos, Ayelen Kisch, Alper Yurci, Fatih Güzelbulut, Yasir Furkan Çağın, Enver Avcı, Murat Akyıldız, Emine Kübra Dindar‐Demiray, Murat Harputluoğlu, Rahul Kumar, Sanjaya K. Satapathy, Manuel Mendizabal, Marcelo Silva, Stefano Fagiuoli, Stuart K. Roberts, Neşe Karadağ Soylu, Ramazan Idilman, Eric M. Yoshida, Aldo J. Montano‐Loza, George N. Dalekos, Ezequiel Ridruejo, Thomas D. Schiano, Staffan Wahlin
Institutions: Harran University, Asian Institute of Gastroenterology, Epatocentro Ticino, Università della Svizzera italiana, Ospedale Papa Giovanni XXIII, Medical University of Vienna, Gülhane Eğitim ve Araştırma Hastanesi, The Alfred Hospital, Alfred Health, Indiana University School of Medicine, University of Basel, Kırıkkale University, Hospital General de México, Hospital Alemán, University of Alberta, Akdeniz University, Hospital de São João, World Gastroenterology Organisation, Hospital Muñiz, Diyarbakır Gazi Yaşargil Eğitim ve Araştırma Hastanesi, Ankara University, Haseki Eğitim ve Araştırma Hastanesi, Hacettepe University, Hospital Clínico de la Universidad de Chile, University of Chile, Inonu University, Universidad Nacional de Asunción, Ege University, Hospital Clínic de Barcelona, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, National and Kapodistrian University of Athens, Erciyes University, Haydarpaşa Numune Eğitim ve Araştırma Hastanesi, KTO Karatay University, Koç University, Ministry of Health, National University of Singapore, Changi General Hospital, SingHealth Duke-NUS Academic Medical Centre, Duke-NUS Medical School, Northwell Health, Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, Hospital Universitario Austral, Monash University, University of British Columbia, Vancouver General Hospital, University Hospital of Larissa, General Hospital of Larisa, Greece, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Mount Sinai Hospital, Karolinska University Hospital, Karolinska Institutet
Language: English
Subfield: Pharmacology
Domain: Life Sciences
Open Access status: green
OpenAlex ID: W4280521012