COVID-19 vaccination and liver disease

Table 3 Reported cases of liver injury following coronavirus disease 2019 vaccination

Ref.	Age/sex	Past history	Vaccine	Onset	AST/ALT (U/ L)	Total bilirubin (mg/ dL)	IgG	Antibody	Biopsy	Diagnose	Treatment	Outcome
Bril et al[87]	35/F	Third month postpartum	BNT162b2	7 d after the1st dose	754/2001	4.8	Normal	ANA: 1:1280	Interface hepatitis, rosette formation, eosinophil infiltration	Typical for AIH	Prednisone (20 mg/d)	Improved
Lodato et al[88]	43/F	Dyslipidemia	BNT162b2	15 d after the 1st dose	52/51	17.54	Normal	ANA: negative	Moderate portal inflammatory infiltrate with interface hepatitis, biliary injury	Compatible with AIH	Methyl-prednisolone (1 mg/kg/d)	Improved
Vuille-Lessard et al[89]	76/F	Hashimoto's disease, urothelial carcinoma	mRNA-1273	3 d after the 1st dose	811/579	3.8	Increased	ANA: 1:1280, AMA: 1:1280	Interface hepatitis, plasma cells infiltration, pseudorosettes	Compatible with AIH	Prednisolone (40 mg/d) + azathioprine	Improved
Londoño et al[90]	41/F	Premature ovarian failure	mRNA-1273	7 d after the 2nd dose	993/1312	2.3	Increased	ANA: 1:80	Interface hepatitis with a lymphoplasmacytic infiltrate	Typical for AIH	Prednisone (1 mg/kg)	Improved
Rocco et al[91]	80/F	Hashimoto's disease	BNT162b2	7 d after the 3rd dose	1401/1186	10.5	Increased	ANA: 1:160	Interface hepatitis with a lymphoplasmacytic infiltrate	Typical for AIH	Prednisone	Improved
McShane et al[92]	71/F	Osteoarthritis	mRNA-1273	4 d after the 1st dose	-/1067	15.7	Increased	ASMA: 1:2560	Interface hepatitis, eosinophil infiltration	Compatible with AIH	Prednisolone (40 mg/d)	Improved
Clayton-Chubb et al[93]	36/M	Hypertension	AZD1222	26 d after the 1st dose	633/1774	9.9	Normal	ANA: 1:160	Interface hepatitis	Compatible with AIH	Prednisolone (60 mg/d)	Improved
Tan et al[94]	56/F	None	mRNA-1273	35 d after the 1st dose	1124/1701	5.9	Increased	ANA: positive, ASMA: Positive	Interface hepatitis, rosette formation, eosinophil infiltration	Compatible with AIH	Budesonide	Improved
Ghielmetti et al[95]	63/M	Type 2 diabetes, ischemic heart disease	mRNA-1273	7 d after the 1st dose	1127/1038	11.9	Increased	ANA: 1:640	Inflammatory portal infiltrate with interface hepatitis	Typical for AIH	Prednisone (40 mg/d)	Improved
Zhou et al[96]	36/F	Ulcerative colitis, primary sclerosing cholangitis	mRNA-1273	11 d after the 1st dose	581/588	1.4	Increased	ANA: 1:2560	Interface hepatitis with a lymphoplasmacytic infiltrate, rosette, eosinophil	Compatible with AIH	Prednisone (50 mg/d)	Improved
Garrido et al[97]	65/F	JAK2 V617F-positive polycythemia	mRNA-1273	14 d after the 1st dose	1056/1092	1.1	Increased	ANA: 1:100	Interface hepatitis	Compatible with AIH	Prednisolone (60 mg/d)	Improved
Goulas et al[98]	52/F	None	mRNA-1273	14 d after the 1st dose	350/936	9.06	Increased	ANA: 1:320, ASMA: positive	Portal, periportal inflammation, rosette formation	Typical for AIH	Prednisolone (50 mg/d) + azathioprine	Improved
Rela et al[99]	38/F	Hypothyroidism	AZD1222	20 d after the 1st dose	1101/1025	14.9	Increased	ANA: positive	Multiacnar hepatic necrosis and periportal neocholangiolar proliferation	Compatible with AIH	Prednisolone (30 mg/d)	Improved
Rela et al[99]	62/M	None	AZD1222	13 d after the 2nd dose	1361/1094	19.2	NA	ANA: negative	Portal neocholangiolar proliferation and mild to moderate inflammation	Compatible with AIH	Prednisolone (30 mg/d) + plasma exchange	Death
Palla et al[100]	40/F	Sarcoidosis	BNT162b2	28 d after the 2nd dose	4 times upper limit of normal	NA	Increased	ANA: 1:640	Interface hepatitis with plasma cells infiltration	Compatible with AIH	Prednisolone (40 mg/d)	Improved
Mann et al[101]	61/F	Irritable bowel disease, cholecystectomy	BNT162b2	9 d after the 2nd dose	37/37	6.2	NA	ANA: negative	Scattered inflammatory cells consisting of lymphocyte and few eosinophils	Drug induced liver injury	Conservative treatment	Improved
Avci et al[102]	61/F	Hashimoto's disease, hypertension	BNT162b2	28 d after the 1st dose	455/913	11.8	Increased	ANA: 1:100, ASMA: 1:100	Interface hepatitis	Compatible with AIH	Prednisolone (40 mg/d) + azathioprine	Improved
Torrente et al[103]	46/F	Hypothyroidism, anemia	AZD1222	21 d after the 1st dose	241/353	Normal	Increased	ANA: 1:160	Lymphoplasmacytic portal infiltrate	Compatible with AIH	Prednisone (30 mg/d) + azathioprine	Improved
Ghorbani et al[104]	62/M	None	Corona Vac	3 d after the 2nd dose	722/435	8	NA	ANA: negative, ASMA: negative	Interface hepatitis, infiltration of lymphocytes and eosinophils in portal tract	Compatible with AIH	Ursodeoxycholic acid	Improved
Kang et al[105]	27/F	None	BNT162b2	7 d after the 2nd dose	1004/1478	8.6	Increased	ANA: 1:80	Interface hepatitis with a lymphoplasmacytic infiltrate, rosette, eosinophil	Typical for AIH	Prednisolone (40 mg/d)	Improved
Camacho-Domínguez et al[106]	79/M	None	AZD1222	15 d after the 1st dose	2003/1994	11.9	Increased	ANA: 1:80	Interface hepatitis with a lymphocytic infiltrate, eosinophil	Compatible with AIH	Prednisone (30 mg/d) + azathioprine	Improved
Shahrani et al[107]	59/F	Dyslipidemia	AZD1222	12 d after the 2nd dose	962/1178	7.5	Increased	NA	Lympho-plasmacellular portal infiltrate	Compatible with AIH	Prednisolone (40 mg/d)	Improved
Shahrani et al[107]	63/F	Ulcerative colitis, primary sclerosing cholangitis	AZD1222	14 d after the 1st dose	505/354	18.6	Increased	ANA: positive	Interface hepatitis	Compatible with AIH	Prednisolone (40 mg/d)	Improved
Shahrani et al[107]	72/F	None	BNT162b2	10 d after boostershot	1452/2280	1.7	Increased	ANA: negative, AMA: positive	Infiltration of lymphocytes and plasma cells in portal tract	Compatible with AIH	Prednisolone (40 mg/d)	Improved
Zin Tun et al[108]	47/M	None	mRNA-1273	3 d after the 1st dose; A few days after the 2nd dose	NA/1048	11.3	Increased	ANA: positive	Interface hepatitis with a lymphoplasmatic infiltrate, rosette, emperipolesis	Typical for AIH	Prednisolone (40 mg/d)	Improved
Suzuki et al[109]	80/F	Gastroesophageal reflux esophagitis	BNT162b2	10 d after the 2nd dose	995/974	3.5	Increased	ANA: 1:40	Lymphoplasmacytic infiltration in the portal area, interface hepatitis	Compatible with AIH	Prednisone (0.8 mg/kg/d)	Improved
Suzuki et al[109]	75/F	Dyslipidemia	BNT162b2	4 d after the 2nd dose	1085/820	17.7	Increased	ANA: 1:80	Lymphoplasmacytic infiltration in the portal area, interface hepatitis	Compatible with AIH	Prednisone (1.0 mg/kg/d)	Improved
Suzuki et al[109]	78/F	Primary biliary cholangitis	BNT162b2	7 d after the 1st dose	401/542	1.3	Increased	ANA: 1:80	Lymphoplasmacytic infiltration in the portal area, interface hepatitis	Compatible with AIH	Prednisone (0.6 mg/kg/d)	Improved

AIH: Autoimmune hepatitis; AMA: Anti-mitochondrial antibodies; ANA: Anti-nuclear antibodies; ASMA: Anti-smooth muscle antibodies; JAK: Janus kinase; NA: Not available; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; IgG: Immunoglobulin G.