Histologic Features of Liver Injury Associated With SARS-CoV-2 Messenger RNA Vaccines.

Rebecca C Obeng, David J Escobar, Brian Vadasz, Wei Zheng, Jennifer Y Ju, Adam L Booth, Guang-Yu Yang, Sameer Al Diffalha, Deepti Dhall, Maria Westerhoff, Yue Xue
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Abstract

Context.—: Many drugs can induce liver injury; however, vaccine-induced liver injury is a rare phenomenon. SARS-CoV-2 messenger RNA (mRNA) vaccines are now widely administered, and clinical evidence of liver injury has been reported.

Objective.—: To characterize the histologic features of SARS-CoV-2 mRNA vaccine-associated liver injury.

Design.—: Thirteen liver biopsies from 12 patients with elevated liver enzymes clinically favored to be secondary to SARS-CoV-2 mRNA vaccine were identified between 2021 and 2022. Demographics, clinical information, and histologic features of liver biopsies were reviewed.

Results.—: All patients (median age, 58 years; M:F = 4:8) received at least 1 dose of SARS-CoV-2 mRNA vaccines (7 Pfizer and 5 Moderna). Four patients had a history of liver disease. Nine patients developed symptoms between 1 day and 2 months after receiving the vaccine dose. Viral serologies were negative. Drug-induced liver injury was thought to be less likely clinically in the 3 patients who had started new medications. Autoimmune antibodies were detected in 9 patients. Moderate to severe active hepatitis was the dominant histologic pattern of injury (9 of 13 biopsies; 69%). Resolving hepatitis, cholestatic hepatitic injury, and bile duct injury were identified in 1 biopsy each. All patients recovered spontaneously or with steroid therapy except one patient who developed autoimmune hepatitis.

Conclusions.—: Moderate to severe active hepatitis is commonly observed in SARS-CoV-2 mRNA vaccine-associated liver injury, and female patients may be more susceptible to injury. Liver injury resolves spontaneously or with steroid treatment. In rare cases, these vaccines may trigger an underlying immune condition.

与 SARS-CoV-2 信使 RNA 疫苗相关的肝损伤的组织学特征。
背景许多药物可诱发肝损伤,但疫苗诱发肝损伤的现象却很少见。目前,SARS-CoV-2 信使 RNA (mRNA) 疫苗已被广泛接种,并且已有肝损伤的临床证据报道:描述 SARS-CoV-2 mRNA 疫苗相关肝损伤的组织学特征:在 2021 年至 2022 年期间,确定了 12 名临床上认为继发于 SARS-CoV-2 mRNA 疫苗的肝酶升高患者的 13 例肝活检。对肝活检的人口统计学、临床信息和组织学特征进行了审查:所有患者(中位年龄 58 岁,男女比例 4:8)至少接种过一剂 SARS-CoV-2 mRNA 疫苗(辉瑞公司 7 剂,Moderna 公司 5 剂)。四名患者有肝病史。九名患者在接种疫苗 1 天至 2 个月后出现症状。病毒血清学检测结果均为阴性。临床上认为,3 名开始服用新药的患者不太可能出现药物性肝损伤。在 9 名患者中检测到了自身免疫抗体。中度至重度活动性肝炎是主要的损伤组织学模式(13 例活检中的 9 例;69%)。缓解性肝炎、胆汁淤积性肝炎和胆管损伤各在 1 例活检中发现。除了一名患者发展为自身免疫性肝炎外,所有患者都能自愈或接受类固醇治疗:结论:SARS-CoV-2 mRNA 疫苗相关性肝损伤中常可观察到中度至重度活动性肝炎,女性患者可能更容易受到损伤。肝损伤可自行缓解或经类固醇治疗后缓解。在极少数情况下,这些疫苗可能会引发潜在的免疫状况。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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