Liver injury after SARS-CoV-2 vaccination: Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome
Efe, C.; Kulkarni, A.V.; Terziroli Beretta-Piccoli, B.; Magro, B.; Friedrich Stättermayer, A.; Cengiz, M.; Clayton-Chubb, D.; Lammert, C.; Bernsmeier, C.; Gül, Ö.; la Tijera, F.H.-D.; Anders, M.; Lytvyak, E.; Akın, M.; Purnak, T.; Liberal, R.; Peralta, M.; Ebik, B.; Duman, S.; Demir, N.; Balaban, Y.; Urzua, Á.; Contreras, F.; Venturelli, M.G.; Bilgiç, Y.; Medina, A.; Girala, M.; Günşar, F.; Londoño, M.-C.; Androutsakos, T.; Kisch, A.; Yurci, A.; Güzelbult, F.; Çağın, Y.F.; Avcı, E.; Güzelbulut, M.; Dindar-Demiray, E.K.; Harputluoğlu, M.; Kumar, R.; Satapathy, S.K.; Mendizabal, M.; Silva, M.; Fagiuoli, S.; Roberts, S.K.; Soylu, N.K.; Idilman, R.; Yoshida, E.M.; Montano-Loza, A.J.; Dalekos, G.N.; Ridruejo, E.; Schiano, T.D.; Wahlin, S.
Tarih:
2022
Özet:
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 Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution.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. © 2022 American Association for the Study of Liver Diseases.
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