Histological and serological features of acute liver injury after SARS-CoV-2 vaccination
JHEP Reports
; 5(1), 2023.
Article
in English
| Scopus | ID: covidwho-2239870
ABSTRACT
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. © 2022 The Author(s)
ad26.cov2.s vaccine; aminotransferase; antinuclear antibody; azathioprine; covilo; elasomeran; microsome antibody; mitochondrion antibody; nvx-cov2373 vaccine; parietal cell antibody; SARS-CoV-2 vaccine; smooth muscle antibody; sputnik v vaccine; steroid; tozinameran; vaxzevria; adult; aged; aging; aminotransferase blood level; Article; autoimmunity; cohort analysis; coronavirus disease 2019; disease association; disease severity; drug exposure; drug safety; female; follow up; hepatitis; histology; human; human tissue; liver biopsy; liver fibrosis; liver injury; liver transplantation; lobular hepatitis; major clinical study; male; portal hepatitis; recurrent disease; serology; sex ratio; acute liver injury; autoimmune liver serology; liver histology; SARS-CoV-2 vaccines
Full text:
Available
Collection:
Databases of international organizations
Database:
Scopus
Topics:
Vaccines
Language:
English
Journal:
JHEP Reports
Year:
2023
Document Type:
Article
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