Clinical course and prognostic risk factors of SARS-CoV-2 vaccine-related hepatitis: differentiating severe acute respiratory syndrome coronavirus 2 vaccine-associated liver injury from autoimmune hepatitis.
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Malino Donald, Codoni Greta, Kirchner Theresa, Engel Bastian, Villamil Alejandra Maria, Efe Cumali, Stättermayer Albert Friedrich, Weltzsch Jan Philipp, Sebode Marcial, Bernsmeier Christine, Lleo Ana, Gevers Tom J G, Kupčinskas Limas, Castiella Agustin, Pinazo Jose, De Martin Eleonora, Bobis Ingrid, Sandahl Thomas Damgaard, Pedica Federica, Invernizzi Federica, Del Poggio Paolo, Bruns Tony, Kolev Mirjam, Semmo Nasser, Bessone Fernando, Giguet Baptiste, Poggi Guido, Ueno Masayuki, Jang Helena, Elpek Gülsüm Özlem, Soylu Neşe Karadağ, Cerny Andreas, Wedemeyer Heiner, Matter Matthias S, Uzun Sarp, Matilla-Cabello Gonzalo, Vergani Diego, Mieli-Vergani Giorgina, Lucena M Isabel, Andrade Raul J, Zen Yoh, Taubert Richard, Terziroli Beretta-Piccoli Benedetta
Аннотация
METHODS: Members of the International AIH Group and the European Reference Network on Hepatological Diseases who contributed cases to our original cohort provide follow-up data at 6 months, 12 months, and at last follow-up.
RESULTS: Sixty-two patients (median age 56 years, 35 female) were included (median follow-up: 22.8 months). Fifty-eight (93%) received steroids ± azathioprine/mycophenolate. Four died of non-liver-related causes. Transaminases normalization rates were 71, 92, and 90% at 6 months, 12 months, and last follow-up, respectively. Twenty-four had a DI-ALH-like course, with ALT normalization and no relapse with or without ( n = 4) a short (<9 months) immunosuppressive treatment. Nineteen had an AIH-like course, with relapse after discontinuation ( n = 11) or persistent ALT elevation despite treatment ( n = 8). Nineteen were unclassified. Risk factors for AIH-like progression included a higher revised AIH score, advanced fibrosis, and severe interface hepatitis.
CONCLUSION: Most cases resemble DI-ALH, which we propose naming severe acute respiratory syndrome coronavirus 2 vaccine-associated liver injury, but a significant subset requires long-term immunosuppression, resembling classical AIH.