Liver injury after SARS-CoV-2 vaccination: Features of immune-mediated

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 Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution.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.

C1 [Efe, Cumali] Harran Univ Hosp, Dept Gastroenterol, Sanliurfa, Turkey.

[Kulkarni, Anand V.] Asian Inst Gastroenterol Hosp, Dept Hepatol & Liver Transplantat, Hyderabad, India.

[Terziroli Beretta-Piccoli, Benedetta] Univ Svizzera Italiana, Fac Biomed Sci, Lugano, Switzerland.

[Terziroli Beretta-Piccoli, Benedetta] Epatocentro Ticino, Lugano, Switzerland.

[Magro, Bianca] ASST Papa Giovanni XXIII Bergamo, Gastroenterol Hepatol & Transplantat, Bergamo, Italy.

[Friedrich Staettermayer, Albert] Med Univ Vienna, Div Gastroenterol & Hepatol, Dept Internal Med 3, Vienna, Austria.

[Cengiz, Mustafa] Gulhane Training & Res Hosp, Dept Gastroenterol, Ankara, Turkey.

[Clayton-Chubb, Daniel] Alfred Hlth, Dept Gastroenterol, Melbourne, Vic, Australia.

[Lammert, Craig] Univ Sch Med, Dept Med Indiana, Indianapolis, IN USA.

[Bernsmeier, Christine] Univ Basel, Dept Biomed, Basel, Switzerland.

[Bernsmeier, Christine] Univ Ctr Gastrointestinal & Liver Dis, Basel, Switzerland.

[Gul, Ozlem] Kirikkale Univ, Dept Gastroenterol, Kirikkale, Turkey.

[Higuera-de la Tijera, Fatima] Hosp Gen Mexico City, Gastroenterol & Hepatol Unit, Ciudad Mexico, Mexico.

[Anders, Margarita] Hosp Aleman, Hepatol & Liver Transplant Unit, Buenos Aires, Argentina.

[Lytvyak, Ellina] Univ Alberta, Div Gastroenterol, Edmonton, AB, Canada.

[Lytvyak, Ellina] Univ Alberta, Liver Unit, Edmonton, AB, Canada.

[Akin, Mete] Akdeniz Univ, Dept Gastroenterol, Fac Med, Antalya, Turkey.

[Purnak, Tugrul] McGovern Med Sch, Div Gastroenterol Hepatol & Nutr, Houston, TX USA.

[Liberal, Rodrigo] Ctr Hosp & Univ Sao Joao, Dept Gastroenterol & Hepatol, Porto, Portugal.

[Liberal, Rodrigo] World Gastroenterol Org WGO, Porto Training Ctr, Porto, Portugal.

[Peralta, Mirta] Hosp Francisco J Muniz, Hepatol Sect, Buenos Aires, Argentina.

[Peralta, Mirta; Ridruejo, Ezequiel] Latin Amer Liver Res Educ & Awareness Network LAL, Pilar, Argentina.

[Ebik, Berat] Gazi Yasargil Educ & Res Hosp, Dept Gastroenterol, Diyarbakir, Turkey.

[Duman, Serkan; Idilman, Ramazan] Ankara Univ Med Fac, Dept Gastroenterol, Fac Med, Ankara, Turkey.

[Demir, Nurhan] Haseki Training & Res Hosp, Dept Gastroenterol, Istanbul, Turkey.

[Balaban, Yasemin] Hacettepe Univ, Dept Gastroenterol, Fac Med, Ankara, Turkey.

[Urzua, Alvaro] Hosp Clin Univ Chile, Gastroenterol & Hepatol Unit, Santiago, Chile.

[Contreras, Fernando] Ctr Gastroenterol Avanzada, Santa Dominco, Dominican Rep.

[Venturelli, Maria Grazia] Clin Stella Maris, Gastroenterol & Hepatol Unit, Lima, Peru.

[Bilgic, Yilmaz] Inonu Univ, Dept Gastroenterol, Sch Med, Malatya, Turkey.

[Medina, Adriana; Girala, Marcos; Cagin, Yasir Furkan; Guezelbulut, Murat] Univ Nacl Asunc, Hosp Clin, Gastroenterol & Hepatol Unit, San Lorenzo, Paraguay.

[Guensar, Fulya] Ege Univ, Dept Gastroenterol, Sch Med, Izmir, Turkey.

[Londono, Maria-Carlota] Hosp Clin Barcelona, Liver Unit, IDIBAPS, CIBERehd, Barcelona, Spain.

[Androutsakos, Theodoros] Natl & Kapodistrian Univ Athens, Sch Med, Dept Pathophysiol, Athens, Greece.

[Kisch, Ayelen] Hosp Bonorino Udaondo, Hepatol Sect, Buenos Aires, DF, Argentina.

[Yurci, Alper] Erciyes Univ, Dept Gastroenterol, Sch Med, Kayseri, Turkey.

[Guezelbult, Fatih] Haydarpasa Numune Educ & Res Hosp, Dept Gastroenterol, Istanbul, Turkey.

[Avci, Enver] KTO Karatay Univ, Department Gastroenterol, Affiliated Konya Med Hosp, Med Sch, Konya, Turkey.

[Guezelbulut, Murat] Koc Univ, Dept Gastroenterol, Sch Med, Istanbul, Turkey.

[Dindar-Demiray, Emine Kubra] Bitlis Tatvan State Hosp, Dept Infect Dis & Clin Microbiol, Bitlis, Turkey.

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Donald & Barbara Zucker Sch Med, Dept Internal Med, Northwell Hlth, Manhasset, NY USA.

[Satapathy, Sanjaya K.] Hosp Univ Austral, Hepatol & Liver Transplant Unit, Pilar, Argentina.

[Mendizabal, Manuel; Silva, Marcelo] Monash Univ, Dept Med, Cent Clin Sch, Melbourne, Vic, Australia.

[Roberts, Stuart K.] Inonu Univ Fac Med, Dept Pathol, Malatya, Turkey.

[Soylu, Nese Karadag] Univ British Columbia, Div Gastroenterol, Vancouver, BC, Canada.

[Soylu, Nese Karadag] Vancouver Gen Hosp, Vancouver, BC, Canada.

[Yoshida, Eric M.] Gen Univ Hosp Larissa, Natl Expertise Ctr Greece Autoimmune Liver Dis, Dept Med & Res Lab Internal Med, Larisa, Greece.

[Dalekos, George N.] Gen Univ Hosp Larissa, European Reference Network Hepatol Dis ERN RARE, Larisa, Greece.

[Dalekos, George N.] CEMIC, Ctr Educ Med & Invest Clin, Hepatol Sect, Dept Med, Buenos Aires, DF, Argentina.

[Ridruejo, Ezequiel] Mt Sinai Med Ctr, Div Liver Dis, New York, NY USA.

[Schiano, Thomas D.] Karolinska Inst, Hepatol Div, Dept Upper GI Dis, Stockholm, Sweden.

[Wahlin, Staffan] Karolinska Univ Hosp, Stockholm, Sweden.