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World J Gastroenterol. Dec 28, 2022; 28(48): 6791-6810
Published online Dec 28, 2022. doi: 10.3748/wjg.v28.i48.6791
COVID-19 vaccination and liver disease
Sotaro Ozaka, Takashi Kobayashi, Kazuhiro Mizukami, Kazunari Murakami
Sotaro Ozaka, Kazuhiro Mizukami, Kazunari Murakami, Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu 879-5593, Oita, Japan
Sotaro Ozaka, Takashi Kobayashi, Department of Infectious Disease Control, Faculty of Medicine, Oita University, Yufu 879-5593, Oita, Japan
Author contributions: Ozaka S wrote and edited the manuscript; Mizukami K reviewed and edited the manuscript; Murakami K and Kobayashi T provided oversight for the manuscript and revised it for important intellectual content; all authors issued final approval for the version to be submitted.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sotaro Ozaka, MD, PhD, Assistant Professor, Department of Gas-troenterology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu 879-5593, Oita, Japan. ozakaso@oita-u.ac.jp
Received: September 2, 2022
Peer-review started: September 2, 2022
First decision: October 20, 2022
Revised: November 7, 2022
Accepted: December 6, 2022
Article in press: December 6, 2022
Published online: December 28, 2022
Abstract

Various vaccines against severe acute respiratory syndrome coronavirus 2 have been developed in response to the coronavirus disease 2019 (COVID-19) global pandemic, several of which are highly effective in preventing COVID-19 in the general population. Patients with chronic liver diseases (CLDs), particularly those with liver cirrhosis, are considered to be at a high risk for severe COVID-19 and death. Given the increased rates of disease severity and mortality in patients with liver disease, there is an urgent need to understand the efficacy of vaccination in this population. However, the data regarding efficacy and safety of COVID-19 vaccination in patients with CLDs is limited. Indeed, several organ-specific or systemic immune-mediated side effects following COVID-19 vaccination, including liver injury similar to autoimmune hepatitis, have been recently reported. Although the number of cases of vaccine-related liver injury is increasing, its frequency, clinical course, and mechanism remain unclear. Here, we review the current findings on COVID-19 vaccination and liver disease, focusing on: (1) The impact of COVID-19 in patients with CLD; (2) The efficacy, safety, and risk-benefit profiles of COVID-19 vaccines in patients with CLD; and (3) Liver injury following COVID-19 vaccination.

Keywords: COVID-19 vaccine, Liver disease, Side effect, Liver injury, Immune-related hepatitis, Autoimmune hepatitis

Core Tip: Patients with chronic liver disease (CLD), including cirrhosis, are a high-risk group for severe coronavirus disease 2019 (COVID-19). Presently, the results of several clinical trials for measuring the efficacy and safety of the available COVID-19 vaccines in patients with CLD have been reported. Given the increased rates of severity and mortality of COVID-19 in patients with CLD, the importance of aggressive vaccination in the effective management of severe acute respiratory syndrome coronavirus 2 infection should be emphasized. Although liver injury following COVID-19 vaccination has also been reported, it is infrequent and is not a factor in vaccine hesitancy.