Histological and serological features of acute liver injury after SARS-CoV-2 vaccination
© 2022 The Author(s)..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:5 |
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| Enthalten in: |
JHEP reports : innovation in hepatology - 5(2023), 1 vom: 18. Jan., Seite 100605 |
| Sprache: |
Englisch |
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| Links: |
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| Anmerkungen: |
Date Revised 29.11.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.jhepr.2022.100605 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM349531617 |
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| 100 | 1 | |a Codoni, Greta |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Histological and serological features of acute liver injury after SARS-CoV-2 vaccination |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Revised 29.11.2022 | ||
| 500 | |a published: Electronic-eCollection | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a © 2022 The Author(s). | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a AIH, autoimmune hepatitis | |
| 650 | 4 | |a ALP, alkaline phosphatase | |
| 650 | 4 | |a ALT, alanine aminotransferase | |
| 650 | 4 | |a AMA, anti-mitochondrial antibody | |
| 650 | 4 | |a ANA, anti-nuclear antibody | |
| 650 | 4 | |a AST, aspartate aminotransferase | |
| 650 | 4 | |a COVID-19, coronavirus disease 2019 | |
| 650 | 4 | |a DILI, drug-induced liver injury | |
| 650 | 4 | |a IAIHG, International Autoimmune Hepatitis Group | |
| 650 | 4 | |a IFT, indirect immunofluorescence | |
| 650 | 4 | |a LKM, liver kidney microsomal | |
| 650 | 4 | |a LT, liver transplantation | |
| 650 | 4 | |a PCA, parietal cell antigen | |
| 650 | 4 | |a SARS-CoV-2 vaccines | |
| 650 | 4 | |a SARS-CoV-2, severe acute respiratory syndrome coronavirus type 2 | |
| 650 | 4 | |a SLA, soluble liver antigen | |
| 650 | 4 | |a SMA, anti-smooth muscle antibody | |
| 650 | 4 | |a ULN, upper limit of normal | |
| 650 | 4 | |a acute liver injury | |
| 650 | 4 | |a autoimmune liver serology | |
| 650 | 4 | |a liver histology | |
| 650 | 4 | |a pIgG, polyreactive IgG | |
| 700 | 1 | |a Kirchner, Theresa |e verfasserin |4 aut | |
| 700 | 1 | |a Engel, Bastian |e verfasserin |4 aut | |
| 700 | 1 | |a Villamil, Alejandra Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Efe, Cumali |e verfasserin |4 aut | |
| 700 | 1 | |a Stättermayer, Albert Friedrich |e verfasserin |4 aut | |
| 700 | 1 | |a Weltzsch, Jan Philipp |e verfasserin |4 aut | |
| 700 | 1 | |a Sebode, Marcial |e verfasserin |4 aut | |
| 700 | 1 | |a Bernsmeier, Christine |e verfasserin |4 aut | |
| 700 | 1 | |a Lleo, Ana |e verfasserin |4 aut | |
| 700 | 1 | |a Gevers, Tom Jg |e verfasserin |4 aut | |
| 700 | 1 | |a Kupčinskas, Limas |e verfasserin |4 aut | |
| 700 | 1 | |a Castiella, Agustin |e verfasserin |4 aut | |
| 700 | 1 | |a Pinazo, Jose |e verfasserin |4 aut | |
| 700 | 1 | |a De Martin, Eleonora |e verfasserin |4 aut | |
| 700 | 1 | |a Bobis, Ingrid |e verfasserin |4 aut | |
| 700 | 1 | |a Sandahl, Thomas Damgaard |e verfasserin |4 aut | |
| 700 | 1 | |a Pedica, Federica |e verfasserin |4 aut | |
| 700 | 1 | |a Invernizzi, Federica |e verfasserin |4 aut | |
| 700 | 1 | |a Del Poggio, Paolo |e verfasserin |4 aut | |
| 700 | 1 | |a Bruns, Tony |e verfasserin |4 aut | |
| 700 | 1 | |a Kolev, Mirjam |e verfasserin |4 aut | |
| 700 | 1 | |a Semmo, Nasser |e verfasserin |4 aut | |
| 700 | 1 | |a Bessone, Fernando |e verfasserin |4 aut | |
| 700 | 1 | |a Giguet, Baptiste |e verfasserin |4 aut | |
| 700 | 1 | |a Poggi, Guido |e verfasserin |4 aut | |
| 700 | 1 | |a Ueno, Masayuki |e verfasserin |4 aut | |
| 700 | 1 | |a Jang, Helena |e verfasserin |4 aut | |
| 700 | 1 | |a Elpek, Gülsüm Özlem |e verfasserin |4 aut | |
| 700 | 1 | |a Soylu, Neşe Karadağ |e verfasserin |4 aut | |
| 700 | 1 | |a Cerny, Andreas |e verfasserin |4 aut | |
| 700 | 1 | |a Wedemeyer, Heiner |e verfasserin |4 aut | |
| 700 | 1 | |a Vergani, Diego |e verfasserin |4 aut | |
| 700 | 1 | |a Mieli-Vergani, Giorgina |e verfasserin |4 aut | |
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