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

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dc.authoridElpek, Gulsum Ozlem/0000-0002-1237-5454
dc.authoridBruns, Tony/0000-0002-5576-6914
dc.authoridLleo, Ana/0000-0002-0561-7902
dc.authoridUeno, Masayuki/0000-0002-2497-9327
dc.authoridWeltzsch, Jan Philipp/0000-0002-8015-7600
dc.authoridSandahl, Thomas Damgaard/0000-0001-9807-6852
dc.authoridBernsmeier, Christine/0000-0002-5558-0503
dc.authorwosidElpek, Gulsum Ozlem/C-4878-2016
dc.authorwosidBruns, Tony/C-5720-2011
dc.authorwosidLleo, Ana/AAA-5759-2019
dc.authorwosidPinazo, Jose/JEP-3370-2023
dc.authorwosidUeno, Masayuki/ITV-0271-2023
dc.contributor.authorCodoni, Greta
dc.contributor.authorKirchner, Theresa
dc.contributor.authorEngel, Bastian
dc.contributor.authorVillamil, Alejandra Maria
dc.contributor.authorEfe, Cumali
dc.contributor.authorStaettermayer, Albert Friedrich
dc.contributor.authorWeltzsch, Jan Philipp
dc.date.accessioned2024-08-04T20:53:12Z
dc.date.available2024-08-04T20:53:12Z
dc.date.issued2023
dc.departmentİnönü Üniversitesien_US
dc.description.abstractBackground & 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. Auto immune 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 & PLUSMN; 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.& COPY; 2022 The Author(s). Published by Elsevier B.V. on behalf of European Association for the Study of the Liver (EASL). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).en_US
dc.identifier.doi10.1016/j.jhepr.2022.100605
dc.identifier.issn2589-5559
dc.identifier.issue1en_US
dc.identifier.pmid36440259en_US
dc.identifier.scopus2-s2.0-85142901264en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.urihttps://doi.org/10.1016/j.jhepr.2022.100605
dc.identifier.urihttps://hdl.handle.net/11616/101025
dc.identifier.volume5en_US
dc.identifier.wosWOS:001027746300001en_US
dc.identifier.wosqualityQ1en_US
dc.indekslendigikaynakWeb of Scienceen_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherElsevieren_US
dc.relation.ispartofJhep Reportsen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.subjectacute liver injuryen_US
dc.subjectSARS-CoV-2 vaccinesen_US
dc.subjectliver histologyen_US
dc.subjectautoimmune liver serologyen_US
dc.titleHistological and serological features of acute liver injury after SARS-CoV-2 vaccinationen_US
dc.typeArticleen_US

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