Efe, CumaliKulkarni, Anand V.Beretta-Piccoli, Benedetta TerziroliMagro, BiancaStättermayer, AlbertCengiz, MustafaClayton-Chubb, DanielLammert, CraigBernsmeier, ChristineGül, ÖzlemHiguera-de la Tijera, FatimaAnders, MargaritaLytvyak, EllinaAkın, MetePurnak, TugrulLiberal, RodrigoPeralta, MirtaEbik, BeratDuman, SerkanDemir, NurhanBalaban, YaseminUrzua, ÁlvaroContreras, FernandoVenturelli, Maria GraziaBilgiç, YılmazMedina, AdrianaGirala, MarcosGünşar, FulyaLondoño, Maria-CarlotaAndroutsakos, TheodorosKisch, AyelenYurci, AlperGüzelbulut, FatihÇağın, Yasir FurkanAvcı, EnverAkyıldız, MuratDindar-Demiray, Emine KübraHarputluoğlu, MuratKumar, RahulSatapathy, Sanjaya K.Mendizabal, ManuelSilva, MarceloFagiuoli, StefanoRoberts, Stuart K.Soylu, Neşe KaradağIdilman, RamazanYoshida, Eric M.Montano-Loza, Aldo J.Dalekos, George N.Ridruejo, EzequielSchiano, Thomas D.Wahlin, Staffan2023-08-142023-08-142022Efe C, Kulkarni AV, Terziroli Beretta-Piccoli B, et al. Liver injury after SARS-CoV-2 vaccination: Features of immune-mediated hepatitis, role of corticosteroid therapy and outcome. Hepatology. 2022;76(6):1576-1586. doi:10.1002/hep.32572https://hdl.handle.net/1805/34894Background and aims: A few case reports of autoimmune hepatitis-like liver injury have been reported after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. We evaluated clinical features, treatment response and outcomes of liver injury following SARS-CoV-2 vaccination in a large case series. Approach and results: We collected data from cases in 18 countries. The type of liver injury was assessed with the R-value. The study population was categorized according to features of immune-mediated hepatitis (positive autoantibodies and elevated immunoglobulin G levels) and corticosteroid therapy for the liver injury. We identified 87 patients (63%, female), median age 48 (range: 18-79) years at presentation. Liver injury was diagnosed a median 15 (range: 3-65) days after vaccination. Fifty-one cases (59%) were attributed to the Pfizer-BioNTech (BNT162b2) vaccine, 20 (23%) cases to the Oxford-AstraZeneca (ChAdOX1 nCoV-19) vaccine and 16 (18%) cases to the Moderna (mRNA-1273) vaccine. The liver injury was predominantly hepatocellular (84%) and 57% of patients showed features of immune-mediated hepatitis. Corticosteroids were given to 46 (53%) patients, more often for grade 3-4 liver injury than for grade 1-2 liver injury (88.9% vs. 43.5%, p = 0.001) and more often for patients with than without immune-mediated hepatitis (71.1% vs. 38.2%, p = 0.003). All patients showed resolution of liver injury except for one man (1.1%) who developed liver failure and underwent liver transplantation. Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution. None had a relapse during follow-up. Conclusions: SARS-CoV-2 vaccination can be associated with liver injury. Corticosteroid therapy may be beneficial in those with immune-mediated features or severe hepatitis. Outcome was generally favorable, but vaccine-associated liver injury led to fulminant liver failure in one patient.en-USPublisher PolicyCOVID-19 vaccinesAutoimmune hepatitisSARS-CoV-2Article