Outcomes and factors associated with relapse of vaccine-induced liver injury after SARS CoV-2 immunization: A nationwide study

• Published in: Annals of hepatology Vol. 29; no. 3; p. 101489
• Main Authors: Barreira-Díaz, Ana, Riveiro-Barciela, Mar, Fernández-Bonilla, Eva María, Bernal, Vanesa, Castiella, Agustín, Casado-Martín, Marta, Delgado, Carolina, Londoño, María-Carlota, Díaz-González, Álvaro, Pérez-Medrano, Indhira, Conthe, Andrés, Sala, Margarita, Mateos, Beatriz, Gómez-Camarero, Judith, Antón-Conejero, Dolores, Pozo-Calzada, Carmen Del, Cuenca, Francisca, Villagrasa-Vilella, Ares, Salcedo, Magdalena
• Format: Journal Article
• Language: English
• Published: Mexico Elsevier España, S.L.U 01.05.2024; Elsevier
• Subjects: Adult; Aged; Autoimmune hepatitis; Chemical and Drug Induced Liver Injury - etiology; COVID-19 - epidemiology; COVID-19 - prevention & control; COVID-19 Vaccines - adverse effects; Drug-induced liver injury; Female; Gastroenterology and Hepatology; Hepatotoxicity; Humans; Immunization, Secondary; Immunosuppressive Agents - adverse effects; Liver Transplantation; Male; Middle Aged; Prospective Studies; Recurrence; Retrospective Studies; Risk Factors; SARS CoV-2; Vaccine; SVALI; ColHai registry; ALT; INR; TTP; AMA; ANCA; AEMPS; Hepatotoxicity; AIH; AST; AE; SMA; RUCAM; SARS CoV-2; Vaccine; IQR; AP; LKM; Autoimmune hepatitis; ANA; GGT; Drug-induced liver injury; ALF; ALI; Ig; Liver transplantation; severe acute respiratory syndrome coronavirus-2; anti-neutrophil cytoplasmic antibodies; antinuclear antibodies; alanine aminotransferase; interquartile range; international normalized ratio; SARS CoV-2 vaccine-associated liver injury; anti-smooth muscle antibodies; Spanish registry for autoimmune and cholestatic diseases; Roussel Uclaf causality assessment method; gamma-glutamyltransferase; alkaline phosphatase; anti-liver-kidney microsomal antibodies; anti-mitochondrial antibodies; immunoglobulin; thrombotic thrombocytopenia purpura; adverse event; acute liver injury; aspartate aminotransferase; Spanish agency of medicines and medical devices (AEMPS); acute liver failure
• ISSN: 1665-2681; 2659-5982
• DOI: 10.1016/j.aohep.2024.101489

Different patterns of liver injury have been reported in association with the SARS-CoV-2 vaccines. The aim of this study was to describe a nationwide cohort of patients with SARS CoV-2 vaccine-induced liver injury, focusing on treatment and the evolution after further booster administration. multicentre, retrospective-prospective study, including subjects who developed abnormal liver tests within 90 days after administration of SARS-CoV-2 vaccination. 47 cases were collected: 17 after prime dose and 30 after booster. Age was 57 years, 30 (63.8 %) were female, and 7 (14.9 %) had a history of prior autoimmune hepatitis (AIH). Most cases were non-severe, though 9 (19.1 %) developed acute liver injury or failure (ALF). Liver injury tended to be more severe in those presenting after a booster (p=0.084). Pattern of liver injury was hepatocellular (80.9 %), mixed (12.8 %) and 3 (6.4 %) cholestatic. Liver biopsy was performed on 33 patients; 29 showed findings of AIH. Forty-one (87.2 %) patients received immunosuppressants, mostly corticosteroids (35/41). One required liver transplantation and another died due to ALF. Immunosuppression was discontinued in 6/41 patients without later rebound. Twenty-five subjects received at least one booster and 7 (28.0 %) relapsed from the liver injury, but all were non-severe. Recurrence was less frequent among patients on immunosuppressants at booster administration (28.6 % vs. 88.9 %, p=0.007). SARS CoV-2 vaccine-induced liver injury is heterogeneous but mostly immune-mediated. Relapse of liver injury after re-exposure to vaccine is frequent (28.0 %) but mild. Immunosuppression at booster administration is associated with a lower risk of liver injury.