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Liver injury after SARS-CoV-2 vaccination: Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome.
Efe, Cumali; Kulkarni, Anand V; Terziroli Beretta-Piccoli, Benedetta; Magro, Bianca; Stättermayer, Albert; Cengiz, Mustafa; Clayton-Chubb, Daniel; Lammert, Craig; Bernsmeier, Christine; Gül, Özlem; la Tijera, Fatima Higuera-de; Anders, Margarita; Lytvyak, Ellina; Akin, Mete; Purnak, Tugrul; Liberal, Rodrigo; Peralta, Mirta; Ebik, Berat; Duman, Serkan; Demir, Nurhan; Balaban, Yasemin; Urzua, Álvaro; Contreras, Fernando; Venturelli, Maria Grazia; Bilgiç, Yilmaz; Medina, Adriana; Girala, Marcos; Günsar, Fulya; Londoño, Maria-Carlota; Androutsakos, Theodoros; Kisch, Ayelen; Yurci, Alper; Güzelbulut, Fatih; Çagin, Yasir Furkan; Avci, Enver; Akyildiz, Murat; Dindar-Demiray, Emine Kübra; Harputluoglu, Murat; Kumar, Rahul; Satapathy, Sanjaya K; Mendizabal, Manuel; Silva, Marcelo; Fagiuoli, Stefano; Roberts, Stuart K; Soylu, Nese Karadag; Idilman, Ramazan; Yoshida, Eric M; Montano-Loza, Aldo J; Dalekos, George N; Ridruejo, Ezequiel.
  • Efe C; Department of Gastroenterology, Harran University Hospital, Sanliurfa, Turkey.
  • Kulkarni AV; Department of Hepatology and Liver Transplantation, Asian Institute of Gastroenterology Hospitals, Hyderabad, India.
  • Terziroli Beretta-Piccoli B; Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland.
  • Magro B; Epatocentro Ticino, Lugano, Switzerland.
  • Stättermayer A; Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII-Bergamo, Bergamo, Italy.
  • Cengiz M; Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
  • Clayton-Chubb D; Department of Gastroenterology, Gülhane Training and Research Hospital, Ankara, Turkey.
  • Lammert C; Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia.
  • Bernsmeier C; Department of Medicine Indiana, University School of Medicine, Indianapolis, Indiana, USA.
  • Gül Ö; Department of Biomedicine, University of Basel, Basel, Switzerland.
  • la Tijera FH; University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland.
  • Anders M; Department of Gastroenterology, Kirikkale University, Kirikkale, Turkey.
  • Lytvyak E; Gastroenterology and Hepatology Unit, Hospital General de México, Ciudad de México, Mexico.
  • Akin M; Hepatology and Liver Transplant Unit, Hospital Alemán, Ciudad Autónoma de Buenos Aires, Argentina.
  • Purnak T; Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada.
  • Liberal R; Department of Gastroenterology, Akdeniz University Faculty of Medicine, Antalya, Turkey.
  • Peralta M; Division of Gastroenterology, Hepatology and Nutrition, McGovern Medical School, Houston, Texas, USA.
  • Ebik B; Gastroenterology and Hepatology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal.
  • Duman S; World Gastroenterology Organization (WGO) Porto Training Center, Porto, Portugal.
  • Demir N; Hepatology Section, Hospital Francisco J Muñiz, Ciudad Autónoma de Buenos Aires, Argentina.
  • Balaban Y; Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina.
  • Urzua Á; Department of Gastroenterology, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey.
  • Contreras F; Department of Gastroenterology, Ankara University Medical Faculty, Ankara, Turkey.
  • Venturelli MG; Department of Gastroenterology, Haseki Training and Research Hospital, Istanbul, Turkey.
  • Bilgiç Y; Department of Gastroenterology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
  • Medina A; Gastroenterology and Hepatology Unit, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile.
  • Girala M; Centro de Gastroenterología Avanzada, Santa Dominco, Dominican Republic.
  • Günsar F; Gastroenterology and Hepatology Unit, Clinica Stella Maris, Lima, Peru.
  • Londoño MC; Department of Gastroenterology, Inönü University School of Medicine, Malatya, Turkey.
  • Androutsakos T; Gastroenterology and Hepatology Unit, Hospital de Clínicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay.
  • Kisch A; Gastroenterology and Hepatology Unit, Hospital de Clínicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay.
  • Yurci A; Department of Gastroenterology, Ege University School of Medicine, Izmir, Turkey.
  • Güzelbulut F; Liver Unit, Hospital Clínic Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
  • Çagin YF; Department of Pathophysiology, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
  • Avci E; Hepatology Section, Hospital Bonorino Udaondo, Ciudad Autónoma de Buenos Aires, Argentina.
  • Akyildiz M; Department of Gastroenterology, Erciyes University School of Medicine, Kayseri, Turkey.
  • Dindar-Demiray EK; Department of Gastroenterology, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey.
  • Harputluoglu M; Department of Gastroenterology, Inönü University School of Medicine, Malatya, Turkey.
  • Kumar R; Department of Gastroenterology, KTO Karatay University Medical School Affiliated Konya Medicana Hospital, Konya, Turkey.
  • Satapathy SK; Department of Gastroenterology, Koc University School of Medicine, Istanbul, Turkey.
  • Mendizabal M; Department of Infectious Diseases and Clinical Microbiology, Bitlis Tatvan State Hospital, Bitlis, Turkey.
  • Silva M; Department of Gastroenterology, Inönü University School of Medicine, Malatya, Turkey.
  • Fagiuoli S; Department of Gastroenterology and Hepatology, Changi General Hospital, Medicine Academic Clinical Programme, Sing Health Duke-NUS Academic Medical Centre, Singapore.
  • Roberts SK; Department of Internal Medicine, Donald and Barbara Zucker School of Medicine, Northwell Health, Manhasset, New York, USA.
  • Soylu NK; Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina.
  • Idilman R; Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina.
  • Yoshida EM; Latin American Liver Research Educational and Awareness Network (LALREAN), Pilar, Argentina.
  • Montano-Loza AJ; Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar, Argentina.
  • Dalekos GN; Gastroenterology Hepatology and Transplantation, ASST Papa Giovanni XXIII-Bergamo, Bergamo, Italy.
  • Ridruejo E; Department of Gastroenterology, Alfred Health, Melbourne, Victoria, Australia.
Hepatology ; 76(6): 1576-1586, 2022 12.
Article in English | MEDLINE | ID: covidwho-1843915
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.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Hepatitis, Autoimmune / COVID-19 / Hepatitis A Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Vaccines Limits: Female / Humans / Male / Middle aged Language: English Journal: Hepatology Year: 2022 Document Type: Article Affiliation country: Hep.32572

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Hepatitis, Autoimmune / COVID-19 / Hepatitis A Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study Topics: Vaccines Limits: Female / Humans / Male / Middle aged Language: English Journal: Hepatology Year: 2022 Document Type: Article Affiliation country: Hep.32572