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Terziroli_2022_Elsevier_JHEP reports_Histological and serological features
Journal article

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

  • Codoni, Greta Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland
  • Kirchner, Theresa Dept. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany - European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
  • Engel, Bastian Dept. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany - European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
  • Villamil, Alejandra Maria ORCID HIBA, Buenos Aires, Argentina
  • Efe, Cumali Harran University, Şanlıurfa, Turkey
  • Stättermayer, Albert Friedrich ORCID Medical University of Vienna, Wien, Austria
  • Weltzsch, Jan Philipp I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany - European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
  • Sebode, Marcial ORCID I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Germany - European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
  • Bernsmeier, Christine ORCID University Centre for Gastrointestinal and Liver Diseases, Basel, Switzerland
  • Lleo, Ana ORCID IRCCS Humanitas Research Hospital Milan, Italy - Humanitas University, Pieve Emanuele, Milan, Italy
  • Gevers, Tom JG. ORCID European Reference Network on Hepatological Diseases (ERN RARE-LIVER) - Maastricht University Medical Center, Netherlands
  • Kupcinskas, Limas European Reference Network on Hepatological Diseases (ERN RARE-LIVER) - Lithuanian University of Health Sciences, Kaunas, Lituania
  • Castiella, Agustin Donostia University Hospital, Spain
  • Pinazo, Jose Servicios de Ap Digestivo y Farmacologia Clínica, Hospital Universitario Virgen de la Victoria, IBIMA, Universidad de Málaga, Spain
  • De Martin, Eleonora Hépatologie et Transplantation Hépatique, Hôpital Paul Brousse, Villejuif, France
  • Bobis, Ingrid Städtisches Krankenhaus Kiel, Germany
  • Sandahl, Thomas Damgaard ORCID Aarhus University Hospital, Denmark
  • Pedica, Federica ORCID Ospedale San Raffaele, Milano, Italy
  • Invernizzi, Federica Ospedale San Raffaele, Milano, Italy
  • Del Poggio, Paolo Policlinico San Marco, Zingonia, Italy
  • Bruns, Tony ORCID European Reference Network on Hepatological Diseases (ERN RARE-LIVER) - University Hospital RWTH Aachen, Germany
  • Kolev, Mirjam ORCID Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital Bern, University of Bern, Switzerland
  • Semmo, Nasser Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital Bern, University of Bern, Switzerland
  • Bessone, Fernando ORCID University of Rosario School of Medicine, Rosario, Argentina
  • Giguet, Baptiste Centre Hospitalier Universitaire de Rennes, France
  • Poggi, Guido Istituti Clinici Pavia-Vigevano UO Epatologia Oncologica, Vigevano, Italy
  • Ueno, Masayuki ORCID Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Japan - Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, Japan
  • Jang, Helena Department of Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, Australia
  • Elpek, Gülsüm Özlem ORCID Department of Pathology, Akdeniz University Faculty of Medicine, Antalya, Turkey
  • Soylu, Neşe Karadağ Department of Pathology, Inonu University Faculty of Medicine, Malatya, Turkey
  • Cerny, Andreas Epatocentro Ticino, Lugano, Switzerland
  • Wedemeyer, Heiner Dept. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany - European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
  • Vergani, Diego MowatLabs, Faculty of Life Sciences & Medicine, King’s College London, King’s College Hospital, London, United Kingdom
  • Mieli Vergani, Giorgina MowatLabs, Faculty of Life Sciences & Medicine, King’s College London, King’s College Hospital, London, United Kingdom
  • Lucena, M. Isabel ORCID Servicios de Ap Digestivo y Farmacologia Clínica, Hospital Universitario Virgen de la Victoria, IBIMA, Universidad de Málaga, Spain - Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
  • Andrade, Raul J. Servicios de Ap Digestivo y Farmacologia Clínica, Hospital Universitario Virgen de la Victoria, IBIMA, Universidad de Málaga, Spain - Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
  • Zen, Yoh MowatLabs, Faculty of Life Sciences & Medicine, King’s College London, King’s College Hospital, London, United Kingdom
  • Taubert, Richard Dept. Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Germany - European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
  • Terziroli Beretta-Piccoli, Benedetta ORCID Faculty of Biomedical Sciences, Università della Svizzera italiana, Switzerland - Epatocentro Ticino, Lugano, Switzerland - MowatLabs, Faculty of Life Sciences & Medicine, King’s College London, King’s College Hospital, London, United Kingdom
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  • 2023
Published in:
  • JHEP reports. - 2023, vol. 5, no. 1, p. 100605
Acute liver injury
SARS-CoV-2 vaccines
Liver histology
Autoimmune liver serology
English 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, sh wed 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.
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  • English
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Medicine
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CC BY
Open access status
gold
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https://n2t.net/ark:/12658/srd1331234
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