Efe Cumali, Uzun Sarp, Matter Matthias S, Terziroli Beretta-Piccoli Benedetta
Department of Gastroenterology, Harran University Hospital, Sanlıurfa, Turkey.
Institute of Pathology, University Hospital Basel, Basel, Switzerland.
Liver Int. 2025 Jan;45(1). doi: 10.1111/liv.16209.
Vaccines are the most effective tool against COVID-19 and are generally safe. Very rare and heterogeneous cases of acute liver injury associated to all types of SARS-CoV-2 vaccines have been reported, mostly with autoimmune features. Epidemiological studies used heterogeneous diagnostic criteria and included different populations. Immunological studies in selected cases of acute liver injury linked to mRNA SARS-CoV-2 vaccines suggest that it has a unique pathophysiology, the vaccine-encoded spike protein playing a central role in triggering the aberrant immune response. In most series, liver injury was observed more often following the second vaccine dose. Latency from vaccination to the diagnosis of hepatitis was 1-147 days after the last vaccine dose. Raised immunoglobulin G levels and positive anti-nuclear and/or anti-smooth muscle antibodies are frequent. The vast majority of reported cases have been treated with corticosteroids, mostly associated with azathioprine. Outcome is generally favourable, but cases requiring liver transplantation or causing death have been reported. The heterogeneous clinical entity of acute liver injury linked to SARS-CoV-2 vaccines includes patients requiring long-term immunosuppression, similarly to autoimmune hepatitis, and patients with self-limiting liver damage, possibly representing a unique form of autoimmune-like hepatitis, which we suggest being referred to as SARS-CoV-2 vaccine-associated liver injury (SVALI). Further studies are needed to investigate the pathogenic mechanisms related to the immune response to the spike viral protein in the liver.
疫苗是对抗新冠病毒最有效的工具，且总体安全。已报告了与所有类型的新冠病毒疫苗相关的非常罕见且异质性的急性肝损伤病例，大多具有自身免疫特征。流行病学研究使用了异质性诊断标准，纳入了不同人群。对与新冠病毒mRNA疫苗相关的急性肝损伤特定病例的免疫学研究表明，其具有独特的病理生理学，疫苗编码的刺突蛋白在引发异常免疫反应中起核心作用。在大多数系列研究中，肝损伤在接种第二剂疫苗后更常出现。从接种疫苗到诊断肝炎的潜伏期为最后一剂疫苗接种后的1至147天。免疫球蛋白G水平升高以及抗核抗体和/或抗平滑肌抗体呈阳性很常见。绝大多数报告病例已接受皮质类固醇治疗，大多联合硫唑嘌呤。结果总体良好，但也有需要肝移植或导致死亡的病例报告。与新冠病毒疫苗相关的急性肝损伤这一异质性临床实体包括需要长期免疫抑制的患者，类似于自身免疫性肝炎，以及肝损伤自限的患者，可能代表一种独特的自身免疫样肝炎形式，我们建议将其称为新冠病毒疫苗相关肝损伤（SVALI）。需要进一步研究来探究与肝脏中针对刺突病毒蛋白的免疫反应相关的致病机制。
