作者
Cumali Efe,Anand V. Kulkarni,Benedetta Terziroli Beretta-Piccoli,Bianca Magro,Albert Friedrich Stättermayer,Mustafa Cengiz,Daniel Clayton-Chubb,Alessio Gerussi,Christine Bernsmeier,Özlem Gül,Fatima Higuera-de la Tijera,Margarita Anders,Ellina Lytvyak,Mete Akın,Tugrul Purnak,Rodrigo Liberal,Mirta Peralta,Berat Ebik,Serkan Duman,Nurhan Demir,Laura Cristoferi,Alessio Gerussi,Fernando Contreras,Maria Grazia Venturelli,Yılmaz Bilgiç,Adriana Medina,Marcos Girala,Fulya Günşar,María-Carlota Londoño,Theodoros Androutsakos,Ayelen Kisch,Alper Yurci,Fatih Güzelbult,Yasir Furkan Çağın,Enver Avcı,Murat Akyıldız,Emine Kübra Dindar-Demiray,Murat Harputluoğlu,Rahul Kumar,Sanjaya K. Satapathy,Manuel Mendizabal,Marcelo Silva,Stefano Fagiuoli,Stuart K. Roberts,Neşe Karadağ Soylu,Ramazan Idilman,Eric M Yoshida,Aldo J Montano-Loza,George N Dalekos,Thomas D. Schiano,Thomas D Schiano,Staffan Wahlin
摘要
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 Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution.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.