Autoimmune hepatitis and COVID-19: No increased risk for AIH after vaccination but reduced care

Impact of COVID-19 on the liver and on the care of patients with chronic liver disease, hepatobiliary cancer, and liver transplantation: An updated EASL position paper

“…Epidemiological data from one large European center did not report an increase in new AIH diagnoses despite widespread vaccine uptake [ 257 ]. However, instances of de novo AIH-like liver injury occurring in close proximity to COVID-19 vaccination have been reported in the literature and selected cases are presented in Table 5 .…”

Risk of acute liver injury following the mRNA (BNT162b2) and inactivated (CoronaVac) COVID-19 vaccines

“…Therefore, we cannot exclude the possibility that the number of injurious cases has been underestimated in the literature to date, as well as in our population-based data. Indeed, access to care and patients' hesitancy to comply with medical follow-ups during the pandemic likely masked cases of ALI as shown in a single-center study in Germany (56). The same group reported no increased risk of AIH after COVID-19 vaccination and 25 patients with "newly diagnosed AIH" that was temporally related to the vaccine displayed features of definite pre-existing chronic liver disease (56).…”

“…Indeed, access to care and patients' hesitancy to comply with medical follow-ups during the pandemic likely masked cases of ALI as shown in a single-center study in Germany (56). The same group reported no increased risk of AIH after COVID-19 vaccination and 25 patients with "newly diagnosed AIH" that was temporally related to the vaccine displayed features of definite pre-existing chronic liver disease (56). Therefore, the true incidence of ALI (and possibly AIH) following COVID-19 vaccination is compounded by many confounding factors such as case identification, alternative causes of ALI, and preexisting liver disease.…”

In situ detection of vaccine mRNA in the cytoplasm of hepatocytes during COVID-19 vaccine-related hepatitis

“…There have been other reports of AIH-like hepatitis since the beginning of mRNA-based SARS-CoV2 vaccination. Nevertheless, the incidence of AIH has not increased in 2021 during the COVID-19 vaccination period in Europe 2 , suggesting that triggering a bout of genuine AIH is unlikely the pathogenic mechanism of such vaccine-related events. Some authors have suggested molecular mimicry as a potential mechanism of liver damage 3 although no similarity was found between soluble liver antigen and SARS-CoV2 spike protein 4 .…”