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O-4 CLINICAL, HISTOLOGICAL AND SEROLOGICAL FEATURES OF AUTOIMMUNE-LIKE ACUTE LIVER INJURY AFTER SARS-COV-2 VACCINATION

INTRODUCTION AND OBJECTIVES: Acute autoimmune-like liver injury has been increasingly reported after vaccination against SARS-CoV-2. Pathogenesis, steroid requirement and long-term prognosis are unknown. This study aimed to evaluate clinical, serological and histological features, response to treatm...

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Autores principales: Lopez, Marlene Padilla, Sobenko, Natalia, Olivera, Lucrecia Garcia, Garmendia, Agustina Martinez, Mullen, Eduardo, Casciato, Paola, Marciano, Sebastian, Villamil, Alejandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Published by Elsevier España, S.L. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10030166/
http://dx.doi.org/10.1016/j.aohep.2023.101014
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author Lopez, Marlene Padilla
Sobenko, Natalia
Olivera, Lucrecia Garcia
Garmendia, Agustina Martinez
Mullen, Eduardo
Casciato, Paola
Marciano, Sebastian
Villamil, Alejandra
author_facet Lopez, Marlene Padilla
Sobenko, Natalia
Olivera, Lucrecia Garcia
Garmendia, Agustina Martinez
Mullen, Eduardo
Casciato, Paola
Marciano, Sebastian
Villamil, Alejandra
author_sort Lopez, Marlene Padilla
collection PubMed
description INTRODUCTION AND OBJECTIVES: Acute autoimmune-like liver injury has been increasingly reported after vaccination against SARS-CoV-2. Pathogenesis, steroid requirement and long-term prognosis are unknown. This study aimed to evaluate clinical, serological and histological features, response to treatment and prognosis in patients with post-vaccination acute hepatitis. MATERIALS AND METHODS: We included patients without known pre-existing liver diseases with transaminase levels ≥ 2.5 upper limits of normal within 90 days after the SARS-CoV-2 vaccine with an available liver biopsy. Clinical data and outcomes after a six months follow-up were collected. RESULTS: 17 patients were included,12 females, median age 60 (51,5/66) exposed to vectorial (Sputnik V n=7, AstraZeneca n=6), inactivated (Sinopharm n=3) or ARNm Vaccines (Moderna=1). In 8 patients, liver injury developed after the first dose and in 7 after the second dose and in 2 after the third dose. The median time to the development of injury was 33(23,50/53,50) days. Eight patients had a history of extrahepatic autoimmune disease and five patients had metabolic syndrome and used statins. Immune serology showed anti-antinuclear antibody in 10 (58,8%), anti-smooth muscle antibody in 5(29,4%). 14/17 patients presented with elevated IgG levels. Liver histology showed lobular hepatitis in 13/17, portal hepatitis in 17/17 with plasmocytic lymphocytic infiltrate and 4/17 had eosinophils, 6/17 with severe interface hepatitis, and one patient had fibrosis Ishak stage ≥3. 12/17 (70,5%) were treated with steroids. Transaminases improved in 17 cases and normalized in 6/12 by month 6. Only 1/17 developed liver function deterioration, yet no patient required liver transplantation. Most patients tolerated the tapering of steroids and in 6 azathioprine was started before month 3. CONCLUSIONS: Long-term follow-up might help to differentiate between induced classical autoimmune hepatitis, autoinflammatory self-limited events, or drug-induced liver injury in these patients.
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spelling pubmed-100301662023-03-22 O-4 CLINICAL, HISTOLOGICAL AND SEROLOGICAL FEATURES OF AUTOIMMUNE-LIKE ACUTE LIVER INJURY AFTER SARS-COV-2 VACCINATION Lopez, Marlene Padilla Sobenko, Natalia Olivera, Lucrecia Garcia Garmendia, Agustina Martinez Mullen, Eduardo Casciato, Paola Marciano, Sebastian Villamil, Alejandra Ann Hepatol Article INTRODUCTION AND OBJECTIVES: Acute autoimmune-like liver injury has been increasingly reported after vaccination against SARS-CoV-2. Pathogenesis, steroid requirement and long-term prognosis are unknown. This study aimed to evaluate clinical, serological and histological features, response to treatment and prognosis in patients with post-vaccination acute hepatitis. MATERIALS AND METHODS: We included patients without known pre-existing liver diseases with transaminase levels ≥ 2.5 upper limits of normal within 90 days after the SARS-CoV-2 vaccine with an available liver biopsy. Clinical data and outcomes after a six months follow-up were collected. RESULTS: 17 patients were included,12 females, median age 60 (51,5/66) exposed to vectorial (Sputnik V n=7, AstraZeneca n=6), inactivated (Sinopharm n=3) or ARNm Vaccines (Moderna=1). In 8 patients, liver injury developed after the first dose and in 7 after the second dose and in 2 after the third dose. The median time to the development of injury was 33(23,50/53,50) days. Eight patients had a history of extrahepatic autoimmune disease and five patients had metabolic syndrome and used statins. Immune serology showed anti-antinuclear antibody in 10 (58,8%), anti-smooth muscle antibody in 5(29,4%). 14/17 patients presented with elevated IgG levels. Liver histology showed lobular hepatitis in 13/17, portal hepatitis in 17/17 with plasmocytic lymphocytic infiltrate and 4/17 had eosinophils, 6/17 with severe interface hepatitis, and one patient had fibrosis Ishak stage ≥3. 12/17 (70,5%) were treated with steroids. Transaminases improved in 17 cases and normalized in 6/12 by month 6. Only 1/17 developed liver function deterioration, yet no patient required liver transplantation. Most patients tolerated the tapering of steroids and in 6 azathioprine was started before month 3. CONCLUSIONS: Long-term follow-up might help to differentiate between induced classical autoimmune hepatitis, autoinflammatory self-limited events, or drug-induced liver injury in these patients. Published by Elsevier España, S.L. 2023-03 2023-03-22 /pmc/articles/PMC10030166/ http://dx.doi.org/10.1016/j.aohep.2023.101014 Text en Copyright © 2023 Published by Elsevier España, S.L. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Article
Lopez, Marlene Padilla
Sobenko, Natalia
Olivera, Lucrecia Garcia
Garmendia, Agustina Martinez
Mullen, Eduardo
Casciato, Paola
Marciano, Sebastian
Villamil, Alejandra
O-4 CLINICAL, HISTOLOGICAL AND SEROLOGICAL FEATURES OF AUTOIMMUNE-LIKE ACUTE LIVER INJURY AFTER SARS-COV-2 VACCINATION
title O-4 CLINICAL, HISTOLOGICAL AND SEROLOGICAL FEATURES OF AUTOIMMUNE-LIKE ACUTE LIVER INJURY AFTER SARS-COV-2 VACCINATION
title_full O-4 CLINICAL, HISTOLOGICAL AND SEROLOGICAL FEATURES OF AUTOIMMUNE-LIKE ACUTE LIVER INJURY AFTER SARS-COV-2 VACCINATION
title_fullStr O-4 CLINICAL, HISTOLOGICAL AND SEROLOGICAL FEATURES OF AUTOIMMUNE-LIKE ACUTE LIVER INJURY AFTER SARS-COV-2 VACCINATION
title_full_unstemmed O-4 CLINICAL, HISTOLOGICAL AND SEROLOGICAL FEATURES OF AUTOIMMUNE-LIKE ACUTE LIVER INJURY AFTER SARS-COV-2 VACCINATION
title_short O-4 CLINICAL, HISTOLOGICAL AND SEROLOGICAL FEATURES OF AUTOIMMUNE-LIKE ACUTE LIVER INJURY AFTER SARS-COV-2 VACCINATION
title_sort o-4 clinical, histological and serological features of autoimmune-like acute liver injury after sars-cov-2 vaccination
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10030166/
http://dx.doi.org/10.1016/j.aohep.2023.101014
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