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The authors evaluated 87 cases of liver injury that occurred after SARS-CoV-2 vaccination. The majority (59%) of the cases were attributed to the Pfizer-BioNTech vaccine. Liver injury occurred a median of 15 days after vaccination and was primarily hepatocellular in most cases, with 57% of patients showing features of immune-mediated hepatitis. Corticosteroids were more likely to be given in cases of more severe liver injury (grade 3–4) and to patients with immune-mediated hepatitis. Most patients who received corticosteroids had complete resolution, with only 1 patient requiring liver transplantation for acute liver failure.
SARS-CoV-2 vaccination may be associated with liver injury. Corticosteroid therapy can be beneficial for patients with severe hepatitis or immune-mediated hepatitis.
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 Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution.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.
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.
Liver injury after SARS-CoV-2 vaccination: Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome
Hepatology 2022 Dec 01;76(6)1576-1586, C Efe, AV Kulkarni, B Terziroli Beretta-Piccoli, B Magro, A Stättermayer, M Cengiz, D Clayton-Chubb, C Lammert, C Bernsmeier, Ö Gül, FH la Tijera, M Anders, E Lytvyak, M Akın, T Purnak, R Liberal, M Peralta, B Ebik, S Duman, N Demir, Y Balaban, Á Urzua, F Contreras, MG Venturelli, Y Bilgiç, A Medina, M Girala, F Günşar, MC Londoño, T Androutsakos, A Kisch, A Yurci, F Güzelbulut, YF Çağın, E Avcı, M Akyıldız, EK Dindar-Demiray, M Harputluoğlu, R Kumar, SK Satapathy, M Mendizabal, M Silva, S Fagiuoli, SK Roberts, NK Soylu, R Idilman, EM Yoshida, AJ Montano-Loza, GN Dalekos, E Ridruejo, TD Schiano, S Wahlin