TY - JOUR
T1 - Liver injury after SARS-CoV-2 vaccination
T2 - Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome
AU - Efe, Cumali
AU - Kulkarni, Anand V.
AU - Terziroli Beretta-Piccoli, Benedetta
AU - Magro, Bianca
AU - Stättermayer, Albert
AU - Cengiz, Mustafa
AU - Clayton-Chubb, Daniel
AU - Lammert, Craig
AU - Bernsmeier, Christine
AU - Gül, Özlem
AU - la Tijera, Fatima Higuera de
AU - Anders, Margarita
AU - Lytvyak, Ellina
AU - Akın, Mete
AU - Purnak, Tugrul
AU - Liberal, Rodrigo
AU - Peralta, Mirta
AU - Ebik, Berat
AU - Duman, Serkan
AU - Demir, Nurhan
AU - Balaban, Yasemin
AU - Urzua, Álvaro
AU - Contreras, Fernando
AU - Venturelli, Maria Grazia
AU - Bilgiç, Yılmaz
AU - Medina, Adriana
AU - Girala, Marcos
AU - Günşar, Fulya
AU - Londoño, Maria Carlota
AU - Androutsakos, Theodoros
AU - Kisch, Ayelen
AU - Yurci, Alper
AU - Güzelbulut, Fatih
AU - Çağın, Yasir Furkan
AU - Avcı, Enver
AU - Akyıldız, Murat
AU - Dindar-Demiray, Emine Kübra
AU - Harputluoğlu, Murat
AU - Kumar, Rahul
AU - Satapathy, Sanjaya K.
AU - Mendizabal, Manuel
AU - Silva, Marcelo
AU - Fagiuoli, Stefano
AU - Roberts, Stuart K.
AU - Soylu, Neşe Karadağ
AU - Idilman, Ramazan
AU - Yoshida, Eric M.
AU - Montano-Loza, Aldo J.
AU - Dalekos, George N.
AU - Ridruejo, Ezequiel
AU - Schiano, Thomas D.
AU - Wahlin, Staffan
N1 - Funding Information:
Eric M. Yoshida received grants and honoraria from Intercept. He received grants from Gilead, Merck, AbbVie, Intercept, Genfit, Madrigal, Allergan, Celgene, Pfizer, Paladin Laboratories, and Novodisk. He received honoraria from Lupin. Stefano Fagiuoli advises and is on the speaker's bureau for AbbVie, Gilead, Novartis, and Kedrion. He is on the speakers' bureau for Intercept.
Publisher Copyright:
© 2022 American Association for the Study of Liver Diseases.
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85132426686&partnerID=8YFLogxK
U2 - 10.1002/hep.32572
DO - 10.1002/hep.32572
M3 - Article
C2 - 35567545
AN - SCOPUS:85132426686
SN - 0270-9139
VL - 76
SP - 1576
EP - 1586
JO - Hepatology
JF - Hepatology
IS - 6
ER -