Codoni, Greta; Kirchner, Theresa; Engel, Bastian; Villamil, Alejandra Maria; Efe, Cumali; Stättermayer, Albert Friedrich; Weltzsch, Jan Philipp; Sebode, Marcial; Bernsmeier, Christine; Lleo, Ana; Gevers, Tom Jg; Kupčinskas, Limas; Castiella, Agustin; Pinazo, Jose; De Martin, Eleonora; Bobis, Ingrid; Sandahl, Thomas Damgaard; Pedica, Federica; Invernizzi, Federica; Del Poggio, Paolo; ... (2023). Histological and serological features of acute liver injury after SARS-CoV-2 vaccination. JHEP reports, 5(1), p. 100605. Elsevier 10.1016/j.jhepr.2022.100605
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BACKGROUND & AIMS
Liver injury with autoimmune features after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is increasingly reported. We investigated a large international cohort of individuals with acute hepatitis arising after SARS-CoV-2 vaccination, focusing on histological and serological features.
METHODS
Individuals without known pre-existing liver diseases and transaminase levels ≥5x the upper limit of normal within 3 months after any anti-SARS-CoV-2 vaccine, and available liver biopsy were included. Fifty-nine patients were recruited; 35 females; median age 54 years. They were exposed to various combinations of mRNA, vectorial, inactivated and protein-based vaccines.
RESULTS
Liver histology showed predominantly lobular hepatitis in 45 (76%), predominantly portal hepatitis in 10 (17%), and other patterns in four (7%) cases; seven had fibrosis Ishak stage ≥3, associated with more severe interface hepatitis. Autoimmune serology, centrally tested in 31 cases, showed anti-antinuclear antibody in 23 (74%), anti-smooth muscle antibody in 19 (61%), anti-gastric parietal cells in eight (26%), anti-liver kidney microsomal antibody in four (13%), and anti-mitochondrial antibody in four (13%) cases. Ninety-one percent were treated with steroids ± azathioprine. Serum transaminase levels improved in all cases and were normal in 24/58 (41%) after 3 months, and in 30/46 (65%) after 6 months. One patient required liver transplantation. Of 15 patients re-exposed to SARS-CoV-2 vaccines, three relapsed.
CONCLUSION
Acute liver injury arising after SARS-CoV-2 vaccination is frequently associated with lobular hepatitis and positive autoantibodies. Whether there is a causal relationship between liver damage and SARS-CoV-2 vaccines remains to be established. A close follow-up is warranted to assess the long-term outcomes of this condition.
IMPACT AND IMPLICATIONS
Cases of liver injury after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) have been published. We investigated a large international cohort of individuals with acute hepatitis after SARS-CoV-2 vaccination, focusing on liver biopsy findings and autoantibodies: liver biopsy frequently shows inflammation of the lobule, which is typical of recent injury, and autoantibodies are frequently positive. Whether there is a causal relationship between liver damage and SARS-CoV-2 vaccines remains to be established. Close follow-up is warranted to assess the long-term outcome of this condition.
Item Type: |
Journal Article (Original Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology 04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine |
UniBE Contributor: |
Kolev, Mirjam, Semmo, Nasser |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2589-5559 |
Publisher: |
Elsevier |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
29 Nov 2022 13:26 |
Last Modified: |
20 Jan 2024 10:17 |
Publisher DOI: |
10.1016/j.jhepr.2022.100605 |
PubMed ID: |
36440259 |
Uncontrolled Keywords: |
AIH, autoimmune hepatitis ALP, alkaline phosphatase ALT, alanine aminotransferase AMA, anti-mitochondrial antibody ANA, anti-nuclear antibody AST, aspartate aminotransferase COVID-19, coronavirus disease 2019 DILI, drug-induced liver injury IAIHG, International Autoimmune Hepatitis Group IFT, indirect immunofluorescence LKM, liver kidney microsomal LT, liver transplantation PCA, parietal cell antigen SARS-CoV-2 vaccines SARS-CoV-2, severe acute respiratory syndrome coronavirus type 2 SLA, soluble liver antigen SMA, anti-smooth muscle antibody ULN, upper limit of normal acute liver injury autoimmune liver serology liver histology pIgG, polyreactive IgG |
BORIS DOI: |
10.48350/175258 |
URI: |
https://boris.unibe.ch/id/eprint/175258 |
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