Liver injury after COVID-19 vaccination: Current status and future perspectives

Table 1 Case series focused on new-onset autoimmune hepatitis associated with coronavirus disease 2019 vaccination, n (%)/median (range)

Ref.	n	Demographics: Age, M/F	Pre-exisiting other autoimmune disorders	Pre-exisiting liver diseases	COVID-19 survivor	Vaccine	Injury after 1st/2nd/3rd/4th dose (%)	Pattern of injury (hep/chol/mixed) (%)	The median (range) time from last vacine dose to onset of liver injury (days)
[28]	53	> 11, 13/40	1 (1.9)	3 (6)	NA	mRNA: 48 (91); vector: 5 (9)	32/53/1.9/NA1	NA	8-142
[29]	12	62 (32-80), 6/6	6 (50)	NA	NA	mRNA: 9 (75); vector: 3 (25)	NA	NA	1st: 483; 2nd: 103
[30]4	6	> 39, 0/6	1 (17)	LC: 1 (17); PBC: 1 (17)	NA	mRNA: 6 (100)	33/33/17/17	NA	25 (6-40)
[31]	5	62 (47-72), 1/4	3 (60)	05	NA	mRNA: 3 (60); vector: 2 (40)	40/60/NA/NA	NA	14 (4-46)

¹Information was unavailable for 13% of cases.

²More than 72% of cases had onset within 30 days.

³Median duration (range) calculated from the date of vaccination to the diagnosis of liver injury.

⁴Among 76 individuals who developed acute autoimmune hepatitis following at least one coronavirus disease-19 vaccine dose, six cases occurring within 42 days post-vaccination, with detailed clinical data and a presumed higher likelihood of causal association, were used for analysis.

⁵One case was under evaluation for mild hypertransaminasemia; diagnosis was pending at the time of vaccination.

M: Male; F: Female; AIH: Autoimmune hepatitis; Chol: Cholestatic injury; COVID-19: Coronavirus disease 2019; Hep: Hepatocellular injury; LC: Liver cirrhosis; Mixed: Mixed injury; NA: Not applicable or not available; PBC: Primary biliary cholangitis.