tetano
Editor, Senior Moderator
Eur J Gastroenterol Hepatol
. 2026 Jan 29.
doi: 10.1097/MEG.0000000000003142. Online ahead of print.
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
Donald Malino[SUP] 1 [/SUP], Greta Codoni[SUP] 2 [/SUP], Theresa Kirchner[SUP] 3 4 [/SUP], Bastian Engel[SUP] 3 4 [/SUP], Alejandra Maria Villamil[SUP] 5 [/SUP], Cumali Efe[SUP] 6 [/SUP], Albert Friedrich Stättermayer[SUP] 7 [/SUP], Jan Philipp Weltzsch[SUP] 4 8 [/SUP], Marcial Sebode[SUP] 4 8 [/SUP], Christine Bernsmeier[SUP] 9 [/SUP], Ana Lleo[SUP] 10 [/SUP], Tom J G Gevers[SUP] 4 11 [/SUP], Limas Kupčinskas[SUP] 4 12 [/SUP], Agustin Castiella[SUP] 13 [/SUP], Jose Pinazo[SUP] 14 [/SUP], Eleonora De Martin[SUP] 15 [/SUP], Ingrid Bobis[SUP] 16 [/SUP], Thomas Damgaard Sandahl[SUP] 17 [/SUP], Federica Pedica[SUP] 18 [/SUP], Federica Invernizzi[SUP] 19 [/SUP], Paolo Del Poggio[SUP] 19 [/SUP], Tony Bruns[SUP] 4 20 [/SUP], Mirjam Kolev[SUP] 21 [/SUP], Nasser Semmo[SUP] 21 [/SUP], Fernando Bessone[SUP] 22 [/SUP], Baptiste Giguet[SUP] 23 [/SUP], Guido Poggi[SUP] 24 [/SUP], Masayuki Ueno[SUP] 25 26 [/SUP], Helena Jang[SUP] 27 [/SUP], Gülsüm Özlem Elpek[SUP] 28 [/SUP], Neşe Karadağ Soylu[SUP] 29 [/SUP], Andreas Cerny[SUP] 1 [/SUP], Heiner Wedemeyer[SUP] 3 4 [/SUP], Matthias S Matter[SUP] 30 [/SUP], Sarp Uzun[SUP] 30 [/SUP], Gonzalo Matilla-Cabello[SUP] 14 [/SUP], Diego Vergani[SUP] 31 [/SUP], Giorgina Mieli-Vergani[SUP] 31 [/SUP], M Isabel Lucena[SUP] 14 32 [/SUP], Raul J Andrade[SUP] 14 33 [/SUP], Yoh Zen[SUP] 31 [/SUP], Richard Taubert[SUP] 3 4 [/SUP], Benedetta Terziroli Beretta-Piccoli[SUP] 1 2 31 33 [/SUP]
Affiliations
Background and aim: Reported cases of acute liver injury with autoimmune features post-COVID-19 vaccination raise questions about whether this represents vaccine-triggered autoimmune hepatitis (AIH) or self-limiting drug-induced autoimmune-like hepatitis (DI-ALH). We report follow-up data to determine if the disease course is self-limiting or immunosuppression-dependent.
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.
Keywords: COVID-19 vaccines; autoimmune hepatitis; follow-up; severe acute respiratory syndrome coronavirus 2 vaccine-associated liver injury; vaccine-induced hepatitis.
. 2026 Jan 29.
doi: 10.1097/MEG.0000000000003142. Online ahead of print.
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
Donald Malino[SUP] 1 [/SUP], Greta Codoni[SUP] 2 [/SUP], Theresa Kirchner[SUP] 3 4 [/SUP], Bastian Engel[SUP] 3 4 [/SUP], Alejandra Maria Villamil[SUP] 5 [/SUP], Cumali Efe[SUP] 6 [/SUP], Albert Friedrich Stättermayer[SUP] 7 [/SUP], Jan Philipp Weltzsch[SUP] 4 8 [/SUP], Marcial Sebode[SUP] 4 8 [/SUP], Christine Bernsmeier[SUP] 9 [/SUP], Ana Lleo[SUP] 10 [/SUP], Tom J G Gevers[SUP] 4 11 [/SUP], Limas Kupčinskas[SUP] 4 12 [/SUP], Agustin Castiella[SUP] 13 [/SUP], Jose Pinazo[SUP] 14 [/SUP], Eleonora De Martin[SUP] 15 [/SUP], Ingrid Bobis[SUP] 16 [/SUP], Thomas Damgaard Sandahl[SUP] 17 [/SUP], Federica Pedica[SUP] 18 [/SUP], Federica Invernizzi[SUP] 19 [/SUP], Paolo Del Poggio[SUP] 19 [/SUP], Tony Bruns[SUP] 4 20 [/SUP], Mirjam Kolev[SUP] 21 [/SUP], Nasser Semmo[SUP] 21 [/SUP], Fernando Bessone[SUP] 22 [/SUP], Baptiste Giguet[SUP] 23 [/SUP], Guido Poggi[SUP] 24 [/SUP], Masayuki Ueno[SUP] 25 26 [/SUP], Helena Jang[SUP] 27 [/SUP], Gülsüm Özlem Elpek[SUP] 28 [/SUP], Neşe Karadağ Soylu[SUP] 29 [/SUP], Andreas Cerny[SUP] 1 [/SUP], Heiner Wedemeyer[SUP] 3 4 [/SUP], Matthias S Matter[SUP] 30 [/SUP], Sarp Uzun[SUP] 30 [/SUP], Gonzalo Matilla-Cabello[SUP] 14 [/SUP], Diego Vergani[SUP] 31 [/SUP], Giorgina Mieli-Vergani[SUP] 31 [/SUP], M Isabel Lucena[SUP] 14 32 [/SUP], Raul J Andrade[SUP] 14 33 [/SUP], Yoh Zen[SUP] 31 [/SUP], Richard Taubert[SUP] 3 4 [/SUP], Benedetta Terziroli Beretta-Piccoli[SUP] 1 2 31 33 [/SUP]
Affiliations
- PMID: 41604546
- DOI: 10.1097/MEG.0000000000003142
Background and aim: Reported cases of acute liver injury with autoimmune features post-COVID-19 vaccination raise questions about whether this represents vaccine-triggered autoimmune hepatitis (AIH) or self-limiting drug-induced autoimmune-like hepatitis (DI-ALH). We report follow-up data to determine if the disease course is self-limiting or immunosuppression-dependent.
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.
Keywords: COVID-19 vaccines; autoimmune hepatitis; follow-up; severe acute respiratory syndrome coronavirus 2 vaccine-associated liver injury; vaccine-induced hepatitis.