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Liver injury after SARS‐CoV‐2 vaccination: Features of immune‐mediated hepatitis, role of corticosteroid therapy and outcome

2022; Lippincott Williams & Wilkins; Volume: 76; Issue: 6 Linguagem: Inglês

10.1002/hep.32572

1527-3350

Cumali Efe, Anand V. Kulkarni, Benedetta Terziroli Beretta‐Piccoli, Bianca Magro, Albert Friedrich Stättermayer, Mustafa Cengiz, Daniel Clayton‐Chubb, Craig Lammert, Christine Bernsmeier, Özlem Gül Utku, Fatima Higuera‐de la Tijera, Margarita Anders, Ellina Lytvyak, Mete Akın, Tuğrul Pürnak, Rodrigo Liberal, Mirta Peralta, Berat Ebik, Serkan Duman, Nurhan Demir, Yasemin Balaban, Álvaro Urzúa, F. Contreras, María Grazia Venturelli, Yılmaz Bilgiç, Adriana Medina, Marcos Girala, Fulya Günşar, María‐Carlota Londoño, Θεόδωρος Ανδρουτσάκος, Ayelen Kisch, Alper Yurcı, Fatih Güzelbulut, Yasir Furkan Çağın, Enver Avcı, Murat Akyıldız, Emine Kübra Dindar‐Demiray, Murat Harputluoğlu, Rahul Kumar, Sanjaya K. Satapathy, Manuel Mendizábal, Marcelo Silva, S. Fagiuoli, Stuart K. Roberts, Neşe Karadağ Soylu, Ramazan İdilman, Eric M. Yoshida, Aldo J. Montaño‐Loza, George N. Dalekos, Ezequiel Ridruejo, Thomas D. Schiano, Staffan Wåhlin,

Liver Diseases and Immunity

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.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.