학술논문
Histological and serological features of acute liver injury after SARS-CoV-2 vaccination.
Document Type
Academic Journal
Author
Codoni G; Università della Svizzera Italiana, Facoltà di Scienze Biomediche, Lugano, Switzerland.; Kirchner T; Dept. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.; European Reference Network on Hepatological Diseases (ERN RARE-LIVER).; Engel B; Dept. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.; European Reference Network on Hepatological Diseases (ERN RARE-LIVER).; Villamil AM; HIBA, Buenos Aires, Argentina.; Efe C; Harran University, Şanlıurfa, Turkey.; Stättermayer AF; Medical University of Vienna, Wien, Austria.; Weltzsch JP; I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.; European Reference Network on Hepatological Diseases (ERN RARE-LIVER).; Sebode M; I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.; European Reference Network on Hepatological Diseases (ERN RARE-LIVER).; Bernsmeier C; University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland.; Lleo A; IRCCS Humanitas Research Hospital Milan, Milan, Italy.; Humanitas University, Pieve Emanuele, Milan, Italy.; Gevers TJ; European Reference Network on Hepatological Diseases (ERN RARE-LIVER).; Maastricht University Medical Center, Maastricht, Netherlands.; Kupčinskas L; European Reference Network on Hepatological Diseases (ERN RARE-LIVER).; Lithuanian University of Health Sciences, Kaunas, Lituania.; Castiella A; Donostia University Hospital, Donostia, Spain.; Pinazo J; Servicios de Ap Digestivo y Farmacologia Clínica, Hospital Universitario Virgen de la Victoria, IBIMA, Universidad de Málaga, Malaga, Spain.; De Martin E; Hépatologie et Transplantation Hépatique, Hôpital Paul Brousse, Villejuif, France.; Bobis I; Städtisches Krankenhaus Kiel, Kiel, Germany.; Sandahl TD; Aarhus University Hospital, Aarhus, Denmark.; Pedica F; Ospedale San Raffaele, Milano, Italy.; Invernizzi F; Ospedale San Raffaele, Milano, Italy.; Del Poggio P; Policlinico San Marco, Zingonia, Italy.; Bruns T; European Reference Network on Hepatological Diseases (ERN RARE-LIVER).; University Hospital RWTH Aachen, Aachen, Germany.; Kolev M; Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital Bern, University of Bern, Bern, Switzerland.; Semmo N; Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital Bern, University of Bern, Bern, Switzerland.; Bessone F; University of Rosario School of Medicine, Rosario, Argentina.; Giguet B; Centre Hospitalier Universitaire de Rennes, Rennes, France.; Poggi G; Istituti Clinici Pavia-Vigevano UO Epatologia Oncologica, Vigevano, Italy.; Ueno M; Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan.; Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.; Jang H; Department of Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, Australia.; Elpek GÖ; Department of Pathology, Akdeniz University Faculty of Medicine, Antalya, Turkey.; Soylu NK; Department of Pathology, Inonu University Faculty of Medicine, Malatya 44280, Turkey.; Cerny A; Epatocentro Ticino, Lugano, Switzerland.; Wedemeyer H; Dept. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.; European Reference Network on Hepatological Diseases (ERN RARE-LIVER).; Vergani D; MowatLabs, Faculty of Life Sciences & Medicine, King's College London, King's College Hospital, London, UK.; Mieli-Vergani G; MowatLabs, Faculty of Life Sciences & Medicine, King's College London, King's College Hospital, London, UK.; Lucena MI; Servicios de Ap Digestivo y Farmacologia Clínica, Hospital Universitario Virgen de la Victoria, IBIMA, Universidad de Málaga, Malaga, Spain.; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.; Andrade RJ; Servicios de Ap Digestivo y Farmacologia Clínica, Hospital Universitario Virgen de la Victoria, IBIMA, Universidad de Málaga, Malaga, Spain.; Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.; Zen Y; MowatLabs, Faculty of Life Sciences & Medicine, King's College London, King's College Hospital, London, UK.; Taubert R; Dept. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.; European Reference Network on Hepatological Diseases (ERN RARE-LIVER).; Terziroli Beretta-Piccoli B; Università della Svizzera Italiana, Facoltà di Scienze Biomediche, Lugano, Switzerland.; Epatocentro Ticino, Lugano, Switzerland.; MowatLabs, Faculty of Life Sciences & Medicine, King's College London, King's College Hospital, London, UK.
Source
Publisher: Elsevier B.V Country of Publication: Netherlands NLM ID: 101761237 Publication Model: eCollection Cited Medium: Internet ISSN: 2589-5559 (Electronic) Linking ISSN: 25895559 NLM ISO Abbreviation: JHEP Rep Subsets: PubMed not MEDLINE
Subject
Language
English
Abstract
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.
Competing Interests: The authors do not have any conflict of interest pertaining to this study. Please refer to the accompanying ICMJE disclosure forms for further details.
(© 2022 The Author(s).)
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.
Competing Interests: The authors do not have any conflict of interest pertaining to this study. Please refer to the accompanying ICMJE disclosure forms for further details.
(© 2022 The Author(s).)