Histological and serological features of acute liver injury after SARS-CoV-2 vaccination
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Histological and serological features of acute liver injury after SARS-CoV-2 vaccination. / 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; Bruns, Tony; Kolev, Mirjam; Semmo, Nasser; Bessone, Fernando; Giguet, Baptiste; Poggi, Guido; Ueno, Masayuki; Jang, Helena; Elpek, Gülsüm Özlem; Soylu, Neşe Karadağ; Cerny, Andreas; Wedemeyer, Heiner; Vergani, Diego; Mieli-Vergani, Giorgina; Lucena, M Isabel; Andrade, Raul J; Zen, Yoh; Taubert, Richard; Terziroli Beretta-Piccoli, Benedetta.
In: JHEP REP, Vol. 5, No. 1, 01.2023, p. 100605.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Histological and serological features of acute liver injury after SARS-CoV-2 vaccination
AU - Codoni, Greta
AU - Kirchner, Theresa
AU - Engel, Bastian
AU - Villamil, Alejandra Maria
AU - Efe, Cumali
AU - Stättermayer, Albert Friedrich
AU - Weltzsch, Jan Philipp
AU - Sebode, Marcial
AU - Bernsmeier, Christine
AU - Lleo, Ana
AU - Gevers, Tom Jg
AU - Kupčinskas, Limas
AU - Castiella, Agustin
AU - Pinazo, Jose
AU - De Martin, Eleonora
AU - Bobis, Ingrid
AU - Sandahl, Thomas Damgaard
AU - Pedica, Federica
AU - Invernizzi, Federica
AU - Del Poggio, Paolo
AU - Bruns, Tony
AU - Kolev, Mirjam
AU - Semmo, Nasser
AU - Bessone, Fernando
AU - Giguet, Baptiste
AU - Poggi, Guido
AU - Ueno, Masayuki
AU - Jang, Helena
AU - Elpek, Gülsüm Özlem
AU - Soylu, Neşe Karadağ
AU - Cerny, Andreas
AU - Wedemeyer, Heiner
AU - Vergani, Diego
AU - Mieli-Vergani, Giorgina
AU - Lucena, M Isabel
AU - Andrade, Raul J
AU - Zen, Yoh
AU - Taubert, Richard
AU - Terziroli Beretta-Piccoli, Benedetta
N1 - © 2022 The Author(s).
PY - 2023/1
Y1 - 2023/1
N2 - 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.
AB - 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.
U2 - 10.1016/j.jhepr.2022.100605
DO - 10.1016/j.jhepr.2022.100605
M3 - SCORING: Journal article
C2 - 36440259
VL - 5
SP - 100605
JO - JHEP REP
JF - JHEP REP
SN - 2589-5559
IS - 1
ER -