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Liver injury after SARS-CoV-2 vaccination: features of immune-mediated hepatitis, role of corticosteroid therapy and outcome
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 Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution.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.
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Most affected patients were females (63%) and liver disease was diagnosed a median of 15 days after vaccination.
“Most affected patients were females (63%) and liver disease was diagnosed a median of 15 days after vaccination.”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [45]
Liver tests showed a hepatocellular pattern in the vast majority of cases (84%) of AIH after SARS-CoV-2 vaccination.
“Liver tests showed a hepatocellular pattern in the vast majority of cases (84%).”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [45]
Several case reports and case series followed, with an autoimmune phenotype observed in all cases.
“Several case reports and case series followed, with an autoimmune phenotype observed in all cases.”
From Nomenclature, diagnosis and management of drug-induced autoimmune-like hepatitis (DI-ALH): An expert opinion meeting report (2023) · cites this paper as [45]
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A revised electronic version of RUCAM for the diagnosis of DILI
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Andrade, R. J., Aithal, G. P., de Boer, Y. S., Liberal, R., Gerbes, A., Regev, A., Terziroli Beretta-Piccoli, B., Schramm, C., Kleiner, D. E., De Martin, E., et al. (2023) · Journal of Hepatology · doi:10.1016/j.jhep.2023.04.033 · Cited by 166
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Metadata
- Authors
- Efe, C., Kulkarni, A. V., Terziroli Beretta‐Piccoli, B., Magro, B., Stättermayer, A., Cengiz, M., Clayton‐Chubb, D., Lammert, C., Bernsmeier, C., Gül, Ö., la Tijera, F. H., 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., Androutsakos, T., Kisch, A., Yurci, A., Güzelbulut, F., Çağın, Y. F., Avcı, E., Akyıldız, 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.
- Affiliations
- Department of Gastroenterology,Harran University Hospital,Şanlıurfa,Turkey
- Department of Hepatology and Liver Transplantation,Asian Institute of Gastroenterology Hospitals,Hyderabad,India
- Faculty of Biomedical Sciences,Università Della Svizzera Italiana,Lugano,Switzerland
- Gastroenterology Hepatology and Transplantation,ASST Papa Giovanni XXIII‐Bergamo,Bergamo,Italy
- Division of Gastroenterology and Hepatology,Department of Internal Medicine III,Medical University of Vienna,Vienna,Austria
- Department of Gastroenterology,Gülhane Training and Research Hospital,Ankara,Turkey
- Department of Gastroenterology,Alfred Health,Melbourne,Victoria,Australia
- Department of Medicine Indiana,University School of Medicine,Indianapolis,Indiana,USA
- Department of Biomedicine,University of Basel,Basel,Switzerland
- Department of Gastroenterology,Kırıkkale University,Kırıkkale,Turkey
- Gastroenterology and Hepatology Unit,Hospital General de México,Ciudad de México,Mexico
- Hepatology and Liver Transplant Unit,Hospital Alemán,Ciudad Autónoma de Buenos Aires,Argentina
- Division of Gastroenterology and Liver Unit,University of Alberta,Edmonton,Alberta,Canada
- Department of Gastroenterology,Akdeniz University Faculty of Medicine,Antalya,Turkey
- Division of Gastroenterology,Hepatology and Nutrition,McGovern Medical School,Houston,Texas,USA
- Gastroenterology and Hepatology Department,Centro Hospitalar e Universitário de São João,Porto,Portugal
- Hepatology Section,Hospital Francisco J Muñiz,Ciudad Autónoma de Buenos Aires,Argentina
- Department of Gastroenterology,Gazi Yaşargil Education and Research Hospital,Diyarbakir,Turkey
- Department of Gastroenterology,Ankara University Medical Faculty,Ankara,Turkey
- Department of Gastroenterology,Haseki Training and Research Hospital,Istanbul,Turkey
- Department of Gastroenterology,Faculty of Medicine,Hacettepe University,Ankara,Turkey
- Gastroenterology and Hepatology Unit,Hospital Clínico Universidad de Chile,Santiago de Chile,Chile
- Centro de Gastroenterología Avanzada,Santa Dominco,Dominican Republic
- Gastroenterology and Hepatology Unit,Clinica Stella Maris,Lima,Peru
- Department of Gastroenterology,Inönü University School of Medicine,Malatya,Turkey
- Gastroenterology and Hepatology Unit,Hospital de Clínicas, Universidad Nacional de Asunción,San Lorenzo,Paraguay
- Department of Gastroenterology,Ege University School of Medicine,İzmir,Turkey
- Liver Unit,Hospital Clínic Barcelona,IDIBAPS,CIBERehd,Barcelona,Spain
- Department of Pathophysiology,National and Kapodistrian University of Athens,Medical School,Athens,Greece
- Hepatology Section,Hospital Bonorino Udaondo,Ciudad Autónoma de Buenos Aires,Argentina
- Department of Gastroenterology,Erciyes University School of Medicine,Kayseri,Turkey
- Department of Gastroenterology,Haydarpaşa Numune Education and Research Hospital,İstanbul,Turkey
- Department of Gastroenterology,KTO Karatay University Medical School Affiliated Konya Medicana Hospital,Konya,Turkey
- Department of Gastroenterology,Koc University School of Medicine,Istanbul,Turkey
- Department of Infectious Diseases and Clinical Microbiology,Bitlis Tatvan State Hospital,Bitlis,Turkey
- Department of Gastroenterology and Hepatology,Changi General Hospital,Medicine Academic Clinical Programme,Sing Health Duke‐NUS Academic Medical Centre,Singapore
- Department of Internal Medicine,Donald and Barbara Zucker School of Medicine,Northwell Health,Manhasset,New York,USA
- Latin American Liver Research Educational and Awareness Network (LALREAN),Pilar,Argentina
- Department of Pathology,Inönü University Faculty of Medicine,Malatya,Turkey
- Division of Gastroenterology,University of British Columbia and Vancouver General Hospital,Vancouver,British Columbia,Canada
- Department of Medicine and Research Laboratory of Internal Medicine,National Expertise Center of Greece in Autoimmune Liver Diseases,General University Hospital of Larissa,Larissa,Greece
- Division of Liver Diseases,the Mount Sinai Medical Center,New York,New York,USA
- Hepatology Division, Department of Upper GI Diseases,Karolinska Institutet and Karolinska University Hospital,Stockholm,Sweden
- ORCID
- Venue
- Hepatology
- Published
- 2022-06-23
- Volume
- 76
- Issue
- 6
- Pages
- 1576-1586
- ISSN
- 0270-9139
- 1527-3350
- Cited by
- 106
- References
- 2
- Language
- en
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