tetano
Editor, Senior Moderator
Hepatology
. 2022 May 14.
doi: 10.1002/hep.32572. Online ahead of print.
Liver injury after SARS-CoV-2 vaccination: Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome
Cumali Efe[SUP] 1 [/SUP], Anand V Kulkarni[SUP] 2 [/SUP], Benedetta Terziroli Beretta-Piccoli[SUP] 3 [/SUP], Bianca Magro[SUP] 4 [/SUP], Albert Friedrich Stättermayer[SUP] 5 [/SUP], Mustafa Cengiz[SUP] 6 [/SUP], Daniel Clayton-Chubb[SUP] 7 [/SUP], Craig Lammert[SUP] 8 [/SUP], Christine Bernsmeier[SUP] 9 [/SUP], Özlem Gül[SUP] 10 [/SUP], Fatima Higuera-de la Tijera[SUP] 11 [/SUP], Margarita Anders[SUP] 12 [/SUP], Ellina Lytvyak[SUP] 13 [/SUP], Mete Akın[SUP] 14 [/SUP], Tugrul Purnak[SUP] 15 [/SUP], Rodrigo Liberal[SUP] 16 [/SUP], Mirta Peralta[SUP] 17 18 [/SUP], Berat Ebik[SUP] 19 [/SUP], Serkan Duman[SUP] 20 [/SUP], Nurhan Demir[SUP] 21 [/SUP], Yasemin Balaban[SUP] 22 [/SUP], Álvaro Urzua[SUP] 23 [/SUP], Fernando Contreras[SUP] 24 [/SUP], Maria Grazia Venturelli[SUP] 25 [/SUP], Yılmaz Bilgiç[SUP] 26 [/SUP], Adriana Medina[SUP] 27 [/SUP], Marcos Girala[SUP] 27 [/SUP], Fulya Günşar[SUP] 28 [/SUP], Maria-Carlota Londoño[SUP] 29 [/SUP], Theodoros Androutsakos[SUP] 30 [/SUP], Ayelen Kisch[SUP] 31 [/SUP], Alper Yurci[SUP] 32 [/SUP], Fatih Güzelbult[SUP] 33 [/SUP], Yasir Furkan Çağın[SUP] 26 [/SUP], Enver Avcı[SUP] 34 [/SUP], Murat Akyıldız[SUP] 35 [/SUP], Emine Kübra Dindar-Demiray[SUP] 36 [/SUP], Murat Harputluoğlu[SUP] 26 [/SUP], Rahul Kumar[SUP] 37 [/SUP], Sanjaya K Satapathy[SUP] 38 [/SUP], Manuel Mendizabal[SUP] 18 39 [/SUP], Marcelo Silva[SUP] 18 39 [/SUP], Stefano Fagiuoli[SUP] 4 [/SUP], Stuart K Roberts[SUP] 40 [/SUP], Neşe Karadağ Soylu[SUP] 41 [/SUP], Ramazan Idilman[SUP] 20 [/SUP], Eric M Yoshida[SUP] 42 [/SUP], Aldo J Montano-Loza[SUP] 13 [/SUP], George N Dalekos[SUP] 43 44 [/SUP], Ezequiel Ridruejo[SUP] 18 39 45 [/SUP], Thomas D Schiano[SUP] 46 [/SUP], Staffan Wahlin[SUP] 47 [/SUP]
Affiliations
Abstract
Background& 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& 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 May 14.
doi: 10.1002/hep.32572. Online ahead of print.
Liver injury after SARS-CoV-2 vaccination: Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome
Cumali Efe[SUP] 1 [/SUP], Anand V Kulkarni[SUP] 2 [/SUP], Benedetta Terziroli Beretta-Piccoli[SUP] 3 [/SUP], Bianca Magro[SUP] 4 [/SUP], Albert Friedrich Stättermayer[SUP] 5 [/SUP], Mustafa Cengiz[SUP] 6 [/SUP], Daniel Clayton-Chubb[SUP] 7 [/SUP], Craig Lammert[SUP] 8 [/SUP], Christine Bernsmeier[SUP] 9 [/SUP], Özlem Gül[SUP] 10 [/SUP], Fatima Higuera-de la Tijera[SUP] 11 [/SUP], Margarita Anders[SUP] 12 [/SUP], Ellina Lytvyak[SUP] 13 [/SUP], Mete Akın[SUP] 14 [/SUP], Tugrul Purnak[SUP] 15 [/SUP], Rodrigo Liberal[SUP] 16 [/SUP], Mirta Peralta[SUP] 17 18 [/SUP], Berat Ebik[SUP] 19 [/SUP], Serkan Duman[SUP] 20 [/SUP], Nurhan Demir[SUP] 21 [/SUP], Yasemin Balaban[SUP] 22 [/SUP], Álvaro Urzua[SUP] 23 [/SUP], Fernando Contreras[SUP] 24 [/SUP], Maria Grazia Venturelli[SUP] 25 [/SUP], Yılmaz Bilgiç[SUP] 26 [/SUP], Adriana Medina[SUP] 27 [/SUP], Marcos Girala[SUP] 27 [/SUP], Fulya Günşar[SUP] 28 [/SUP], Maria-Carlota Londoño[SUP] 29 [/SUP], Theodoros Androutsakos[SUP] 30 [/SUP], Ayelen Kisch[SUP] 31 [/SUP], Alper Yurci[SUP] 32 [/SUP], Fatih Güzelbult[SUP] 33 [/SUP], Yasir Furkan Çağın[SUP] 26 [/SUP], Enver Avcı[SUP] 34 [/SUP], Murat Akyıldız[SUP] 35 [/SUP], Emine Kübra Dindar-Demiray[SUP] 36 [/SUP], Murat Harputluoğlu[SUP] 26 [/SUP], Rahul Kumar[SUP] 37 [/SUP], Sanjaya K Satapathy[SUP] 38 [/SUP], Manuel Mendizabal[SUP] 18 39 [/SUP], Marcelo Silva[SUP] 18 39 [/SUP], Stefano Fagiuoli[SUP] 4 [/SUP], Stuart K Roberts[SUP] 40 [/SUP], Neşe Karadağ Soylu[SUP] 41 [/SUP], Ramazan Idilman[SUP] 20 [/SUP], Eric M Yoshida[SUP] 42 [/SUP], Aldo J Montano-Loza[SUP] 13 [/SUP], George N Dalekos[SUP] 43 44 [/SUP], Ezequiel Ridruejo[SUP] 18 39 45 [/SUP], Thomas D Schiano[SUP] 46 [/SUP], Staffan Wahlin[SUP] 47 [/SUP]
Affiliations
- PMID: 35567545
- DOI: 10.1002/hep.32572
Abstract
Background& 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& 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.