BMC Gastroenterology (Oct 2022)

New-onset and relapsed liver diseases following COVID-19 vaccination: a systematic review

  • Saad Alhumaid,
  • Abbas Al Mutair,
  • Ali A. Rabaan,
  • Fatemah M. ALShakhs,
  • Om Prakash Choudhary,
  • Shin Jie Yong,
  • Firzan Nainu,
  • Amjad Khan,
  • Javed Muhammad,
  • Fadil Alhelal,
  • Mohammed Hussain Al Khamees,
  • Hussain Ahmed Alsouaib,
  • Ahmed Salman Al Majhad,
  • Hassan Redha AL-Tarfi,
  • Ali Hussain ALyasin,
  • Yaqoub Yousef Alatiyyah,
  • Ali Ahmed Alsultan,
  • Mohammed Essa Alessa,
  • Mustafa Essa Alessa,
  • Mohammed Ahmed Alissa,
  • Emad Hassan Alsayegh,
  • Hassan N. Alshakhs,
  • Haidar Abdullah Al Samaeel,
  • Rugayah Ahmed AlShayeb,
  • Dalal Ahmed Alnami,
  • Hussain Ali Alhassan,
  • Abdulaziz Abdullah Alabdullah,
  • Ayat Hussain Alhmed,
  • Faisal Hussain AlDera,
  • Khalid Hajissa,
  • Jaffar A. Al-Tawfiq,
  • Awad Al-Omari

DOI
https://doi.org/10.1186/s12876-022-02507-3
Journal volume & issue
Vol. 22, no. 1
pp. 1 – 54

Abstract

Read online

Abstract Background Liver diseases post-COVID-19 vaccination is extremely rare but can occur. A growing body of evidence has indicated that portal vein thrombosis, autoimmune hepatitis, raised liver enzymes and liver injuries, etc., may be potential consequence of COVID-19 vaccines. Objectives To describe the results of a systematic review for new-onset and relapsed liver disease following COVID-19 vaccination. Methods For this systematic review, we searched Proquest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature through the Preferred Reporting Items for Systematic Reviews and Meta Analyses PRISMA guideline for studies on the incidence of new onset or relapsed liver diseases post-COVID-19 vaccination, published from December 1, 2020 to July 31, 2022, with English language restriction. Results Two hundred seventy-five cases from one hundred and eighteen articles were included in the qualitative synthesis of this systematic review. Autoimmune hepatitis (138 cases) was the most frequent pathology observed post-COVID-19 vaccination, followed by portal vein thrombosis (52 cases), raised liver enzymes (26 cases) and liver injury (21 cases). Other cases include splanchnic vein thrombosis, acute cellular rejection of the liver, jaundice, hepatomegaly, acute hepatic failure and hepatic porphyria. Mortality was reported in any of the included cases for acute hepatic failure (n = 4, 50%), portal vein thrombosis (n = 25, 48.1%), splanchnic vein thrombosis (n = 6, 42.8%), jaundice (n = 1, 12.5%), raised liver enzymes (n = 2, 7.7%), and autoimmune hepatitis (n = 3, 2.2%). Most patients were easily treated without any serious complications, recovered and did not require long-term hepatic therapy. Conclusion Reported evidence of liver diseases post-COIVD-19 vaccination should not discourage vaccination against this worldwide pandemic. The number of reported cases is relatively very small in relation to the hundreds of millions of vaccinations that have occurred and the protective benefits offered by COVID-19 vaccination far outweigh the risks.

Keywords