Clinical course and prognostic risk factors of SARS-CoV-2 vaccine-related hepatitis: differentiating severe acute respiratory syndrome coronavirus 2 vaccine-associated liver injury from autoimmune hepatitis

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dc.contributor.authorMalino, Donald
dc.contributor.authorCodoni, Greta
dc.contributor.authorKirchner, Theresa
dc.contributor.authorEngel, Bastian
dc.contributor.authorVillamil, Alejandra Maria
dc.contributor.authorEfe, Cumali
dc.contributor.authorStättermayer, Albert Friedrich
dc.date.accessioned2026-04-04T13:18:58Z
dc.date.available2026-04-04T13:18:58Z
dc.date.issued2026
dc.departmentİnönü Üniversitesi
dc.description.abstractBackground and aim – Reported cases of acute liver injury with autoimmune features post-COVID-19 vaccination raise questions about whether this represents vaccine-triggered autoimmune hepatitis (AIH) or self-limiting drug-induced autoimmune-like hepatitis (DI-ALH). We report follow-up data to determine if the disease course is self-limiting or immunosuppression-dependent. Methods – Members of the International AIH Group and the European Reference Network on Hepatological Diseases who contributed cases to our original cohort provide follow-up data at 6 months, 12 months, and at last follow-up. Results – Sixty-two patients (median age 56 years, 35 female) were included (median follow-up: 22.8 months). Fifty-eight (93%) received steroids ± azathioprine/mycophenolate. Four died of non–liver-related causes. Transaminases normalization rates were 71, 92, and 90% at 6 months, 12 months, and last follow-up, respectively. Twenty-four had a DI-ALH-like course, with ALT normalization and no relapse with or without (n = 4) a short (<9 months) immunosuppressive treatment. Nineteen had an AIH-like course, with relapse after discontinuation (n = 11) or persistent ALT elevation despite treatment (n = 8). Nineteen were unclassified. Risk factors for AIH-like progression included a higher revised AIH score, advanced fibrosis, and severe interface hepatitis. Conclusion – Most cases resemble DI-ALH, which we propose naming severe acute respiratory syndrome coronavirus 2 vaccine-associated liver injury, but a significant subset requires long-term immunosuppression, resembling classical AIH. © 2026
dc.description.sponsorshipDeutsche Forschungsgemeinschaft, DFG; Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, SNF, (320030_189275); Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, SNF
dc.identifier.doi10.1097/MEG.0000000000003142
dc.identifier.issn0954-691X
dc.identifier.pmid41604546
dc.identifier.scopus2-s2.0-105031586862
dc.identifier.scopusqualityQ2
dc.identifier.urihttps://doi.org/10.1097/MEG.0000000000003142
dc.identifier.urihttps://hdl.handle.net/11616/108033
dc.identifier.volumePublish Ahead of Print
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherLippincott Williams and Wilkins
dc.relation.ispartofEuropean Journal of Gastroenterology and Hepatology
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.snmzKA_Scopus_20250329
dc.subjectautoimmune hepatitis
dc.subjectCOVID-19 vaccines
dc.subjectfollow-up
dc.subjectsevere acute respiratory syndrome coronavirus 2 vaccine-associated liver injury
dc.subjectvaccine-induced hepatitis
dc.titleClinical course and prognostic risk factors of SARS-CoV-2 vaccine-related hepatitis: differentiating severe acute respiratory syndrome coronavirus 2 vaccine-associated liver injury from autoimmune hepatitis
dc.typeArticle

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