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; Lleò, Ana; Gevers, Tom J.G.; Kupčinskas, Limas; Castiella, Agustín; Pinazo, Jose; Martin, Eléonora De; Bobis, I.; Sandahl, Thomas Damgaard; Pedica, Federica; Invernizzi, Federica; Poggio, P. Del; Bruns, Tony; Kolev, Mirjam; Semmo, Nasser; Bessone, Fernando; Giguet, Baptiste; Poggi, Geraldina; Ueno, Masashi; Jang, Helena; Elpek, Gülsüm Özlem; Soylu, Neşe Karadağ; Cerny, Andreas; Wedemeyer, Heiner; Vergani, Diego; Mieli‐Vergani, Giorgina; Lucena, M. Isabel; Bellido, Raúl J. Andrade; Zen, Yoh; Taubert, Richard; Beretta‐Piccoli, Benedetta Terziroli

doi:10.1016/j.jhepr.2022.100605

Cited by 25 publications

(48 citation statements)

References 42 publications

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“…A total of 75 eligible papers for investigating hepatic safety of SARS-CoV-2 vaccination were included finally after comprehensive search and rigorous screening. [4] , [5] , [6] , [7] , [8] , [9] , [10] The maximum sample size of concerned SVALI is 4,677 cases from 2,343,288 COVID-19 vaccine recipients without a history of acute liver injury (ALI). 8 Most of the other included studies are scattered case reports.…”

Section: Data Availability Statementmentioning

confidence: 99%

“…The sample size of each study is more than 10 eligible cases in 7 included reports, which was used for the further synthesized analyses. [4] , [5] , [6] , [7] , [8] , [9] , [10] As a necessary supplement, we listed the remaining 68 reports (less than 10 cases) in the Supplementary data to provide additional evidence.…”

Section: Data Availability Statementmentioning

confidence: 99%

“…The total sample size of SVALI is 5,041 cases based on the 7 preferred studies, including 2,136 females and 2,905 males. [4] , [5] , [6] , [7] , [8] , [9] , [10] SVALI, a rare adverse events, may be missed in conventional clinical trials for COVID-19 vaccine because of the insufficient sample sizes. To overcome this limitation, the huge sample sizes of eligible vaccine-exposed cohorts were produced by Wong et al (2,343,288), 8 and Guardiola et al (470,274).…”

Section: Data Availability Statementmentioning

confidence: 99%

“…To overcome this limitation, the huge sample sizes of eligible vaccine-exposed cohorts were produced by Wong et al (2,343,288), 8 and Guardiola et al (470,274). 6 There are substantial clinical and methodological diversity among the 7 studies, [4] , [5] , [6] , [7] , [8] , [9] , [10] such as study design, the definition and criterion (or type) of liver injury, and the clinical variation of populations and interventions. Therefore, we used qualitative/narrative synthesis instead of meta-analysis.…”

Section: Data Availability Statementmentioning

confidence: 99%

“…Therefore, we used qualitative/narrative synthesis instead of meta-analysis. The summary of the 7 preferred studies is presented in Table 1 , [4] , [5] , [6] , [7] , [8] , [9] , [10] which includes the detailed data of study design/ number of cases, geographic location of case source, vaccine, demographic data (age, sex), previous COVID-19 infection, comorbidities, clinical presentation and laboratory data, therapy, and outcome. Importantly, the vast majority of patients recovered from the SVALI by the end of follow-up, including spontaneous resolution of SVALI without treatment.…”

Section: Data Availability Statementmentioning

confidence: 99%

See 4 more Smart Citations

The present evidence summary of SARS-CoV-2 vaccine-associated liver injury: A rapid systematic review

Zheng

Jiang

2023

Journal of Hepatology

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Section: Data Availability Statementmentioning

confidence: 99%

Section: Data Availability Statementmentioning

confidence: 99%

Section: Data Availability Statementmentioning

confidence: 99%

Section: Data Availability Statementmentioning

confidence: 99%

Section: Data Availability Statementmentioning

confidence: 99%

See 3 more Smart Citations

The present evidence summary of SARS-CoV-2 vaccine-associated liver injury: A rapid systematic review

Zheng

Jiang

2023

Journal of Hepatology

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Altered liver function test after Covid‐19 vaccines: A retrospective control group study

Jabif,

Vallone,

Stanek

et al. 2023

Pharmacoepidemiology and Drug

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Background and PurposeLiver injury after Covid‐19 vaccine has been described, although the incidence was not well established. We aimed to compare cumulative incidence of new onset liver test alteration after Covid‐19 vaccination, and to compare with an historical control of influenza vaccination.MethodsWe conducted a retrospective cohort study which included adults who received at least one dose of Covid‐19 vaccine from January 1 to May 30, 2021 and a control group who received a single dose of influenza vaccine during 2019, in a tertiary medical center from Argentina.ResultsWe included 29 798 patients in Covid‐19 vaccine group and 24 605 in influenza vaccine group. Liver function tests were performed in 7833 (26.9%) in Covid‐19 vaccine group and 8459 (34.37%) in influenza vaccine group. Cumulative incidence at 90 days of new onset liver enzyme test alteration was 4.7 per 1000 (95% 4.0–5.5) for Covid‐19 group, and 5.1 per 1000 (95% 4.3–6.1) for the influenza vaccine group (p value = 0.489). Two patients in the Covid‐19 vaccine group developed immune mediated liver injury.ConclusionsWe found no difference in liver test alteration between groups. These findings support the safety of Covid‐19 vaccines. While we have identified two cases that are consistent with immune mediated liver injury following COVID‐19 vaccination, we believe that the available data is insufficient to attribute them solely to the vaccination.

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Defining characteristics and long‐term prognosis of drug‐induced autoimmune‐like hepatitis: A retrospective cohort study

Chung,

Morrison,

Zen

et al. 2023

UEG Journal

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BackgroundDrug‐induced autoimmune‐like hepatitis (DI‐AILH) is poorly defined and more data are required to better characterise and manage this disease entity.ObjectivesThe aim of this study was to evaluate the clinical characteristics, histology and long‐term outcomes of DI‐AILH compared with idiopathic autoimmune hepatitis (AIH).MethodsThis retrospective cohort study reviewed 28 DI‐AILH and 39 AIH patients in a single centre. The new (2022) and simplified (2008) AIH histology criteria were used to assess DI‐AILH.ResultsDI‐AILH were more likely to present with jaundice (p = 0.004) and higher bilirubin levels (p = 0.04) than AIH. AIH patients had higher rate of immunosuppression (IS) use including second‐ and third‐line agents, though the time to reach biochemical remission were comparable. AIH patients had more advanced fibrosis than DI‐AILH (Ishak fibrosis score 3.5 vs. 1.9, p < 0.0001). DI‐AILH more commonly had eosinophilic aggregates (18% vs. 3%, p = 0.031) and less commonly showed plasma cell aggregates (61% vs. 97%, p < 0.001) than AIH. The simplified AIH histology criteria identified 1 atypical histology within the DI‐AILH cohort, although this patient required long‐term IS. The new AIH histology criteria classified 23 (82%) as likely AIH and 5 (18%) as possible AIH. Two of the possible DI‐AILH did not require IS and one patient had successful IS withdrawal. Four DI‐AILH patients with fibrosis stage ≤3 had successful IS withdrawal compared with none in the AIH group. Four patients underwent liver transplantation (LT) in both cohorts with significantly shorter time to LT in DI‐AILH as the indication was for (sub)acute liver failure. Two DI‐AILH patients died within 60 days of LT.ConclusionThe new AIH histology criteria may be better at identifying DI‐AILH. Immunosuppression withdrawal in those without significant fibrosis may be considered. DI‐AILH is at risk of (sub)acute liver failure and early discussions with a transplant centre would be desirable.

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Histological and serological features of acute liver injury after SARS-CoV-2 vaccination

Cited by 25 publications

References 42 publications

The present evidence summary of SARS-CoV-2 vaccine-associated liver injury: A rapid systematic review

The present evidence summary of SARS-CoV-2 vaccine-associated liver injury: A rapid systematic review

Altered liver function test after Covid‐19 vaccines: A retrospective control group study

Defining characteristics and long‐term prognosis of drug‐induced autoimmune‐like hepatitis: A retrospective cohort study

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