1. Liver injury after SARS‐CoV‐2 vaccination: Features of immune‐mediated hepatitis, role of corticosteroid therapy and outcome
- Author
-
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, Efe, C, Kulkarni, A, Terziroli Beretta-Piccoli, B, Magro, B, Friedrich Stattermayer, A, Cengiz, M, Clayton-Chubb, D, Lammert, C, Bernsmeier, C, Gul, O, la Tijera, F, Anders, M, Lytvyak, E, Akin, M, Purnak, T, Liberal, R, Peralta, M, Ebik, B, Duman, S, Demir, N, Balaban, Y, Urzua, A, Contreras, F, Venturelli, M, Bilgic, Y, Medina, A, Girala, M, Gunsar, F, Londono, M, Androutsakos, T, Kisch, A, Yurci, A, Guzelbult, F, Cagin, Y, Avci, E, Guzelbulut, M, Dindar-Demiray, E, Harputluoglu, M, Kumar, R, Satapathy, S, Mendizabal, M, Silva, M, Fagiuoli, S, Roberts, S, Soylu, N, Idilman, R, Yoshida, E, Montano-Loza, A, Dalekos, G, Ridruejo, E, Schiano, T, and Wahlin, S
- Subjects
Male ,COVID-19 Vaccines ,Hepatology ,SARS-CoV-2 ,Vaccination ,VACCINE ,COVID-19 ,Middle Aged ,Hepatitis A ,Hepatitis, Autoimmune ,ChAdOx1 nCoV-19 ,Humans ,Disease ,Female ,Idiopathic Autoimmune Hepatitis ,BNT162 Vaccine - Abstract
© 2022 American Association for the Study of Liver Diseases.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.
- Published
- 2022
- Full Text
- View/download PDF