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.; 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.; 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. · Hepatology (2022) · DOI: 10.1002/hep.32572

Resumen

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 Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution.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.