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Barreira-Díaz A, Riveiro-Barciela M, Fernández-Bonilla EM, Bernal V, Castiella A, Casado-Martín M, Delgado C, Londoño MC, Díaz-González Á, Pérez-Medrano I, Conthe A, Sala M, Mateos B, Gómez-Camarero J, Antón-Conejero D, Pozo-Calzada CD, Cuenca F, Villagrasa-Vilella A, Salcedo M. Outcomes and factors associated with relapse of vaccine-induced liver injury after SARS CoV-2 immunization: A nationwide study. Ann Hepatol 2024; 29:101489. [PMID: 38403068 DOI: 10.1016/j.aohep.2024.101489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/13/2023] [Accepted: 12/05/2023] [Indexed: 02/27/2024]
Abstract
INTRODUCTION AND OBJECTIVES Different patterns of liver injury have been reported in association with the SARS-CoV-2 vaccines. The aim of this study was to describe a nationwide cohort of patients with SARS CoV-2 vaccine-induced liver injury, focusing on treatment and the evolution after further booster administration. PATIENTS AND METHODS multicentre, retrospective-prospective study, including subjects who developed abnormal liver tests within 90 days after administration of SARS-CoV-2 vaccination. RESULTS 47 cases were collected: 17 after prime dose and 30 after booster. Age was 57 years, 30 (63.8 %) were female, and 7 (14.9 %) had a history of prior autoimmune hepatitis (AIH). Most cases were non-severe, though 9 (19.1 %) developed acute liver injury or failure (ALF). Liver injury tended to be more severe in those presenting after a booster (p=0.084). Pattern of liver injury was hepatocellular (80.9 %), mixed (12.8 %) and 3 (6.4 %) cholestatic. Liver biopsy was performed on 33 patients; 29 showed findings of AIH. Forty-one (87.2 %) patients received immunosuppressants, mostly corticosteroids (35/41). One required liver transplantation and another died due to ALF. Immunosuppression was discontinued in 6/41 patients without later rebound. Twenty-five subjects received at least one booster and 7 (28.0 %) relapsed from the liver injury, but all were non-severe. Recurrence was less frequent among patients on immunosuppressants at booster administration (28.6 % vs. 88.9 %, p=0.007). CONCLUSIONS SARS CoV-2 vaccine-induced liver injury is heterogeneous but mostly immune-mediated. Relapse of liver injury after re-exposure to vaccine is frequent (28.0 %) but mild. Immunosuppression at booster administration is associated with a lower risk of liver injury.
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Affiliation(s)
- Ana Barreira-Díaz
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Liver Unit, Hospital Universitario Vall de Hebrón, Barcelona, Spain
| | - Mar Riveiro-Barciela
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Liver Unit, Hospital Universitario Vall de Hebrón, Barcelona, Spain.
| | | | - Vanesa Bernal
- Gastroenterology and Hepatology Department, Miguel Servet University Hospital, Zaragoza, Spain
| | | | | | | | - María-Carlota Londoño
- Institut D'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Liver Unit, Hospital Clínic Barcelona, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Álvaro Díaz-González
- Department of Gastroenterology and Hepatology, Marqués de Valdecilla University Hospital, Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Indhira Pérez-Medrano
- Gastroenterology and Hepatology Department, Complejo Hospitalario Universitario de Pontevedra, Spain
| | - Andrés Conthe
- Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Margarita Sala
- Gastroenterology Department, Hospital Universitari Josep Trueta, Girona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Mateos
- Digestive Department, Hospital Ramón y Cajal, Madrid, Spain
| | | | - Dolores Antón-Conejero
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Digestive Department, Hospital Universitario Dr. Peset, Valencia, Spain
| | | | - Francisca Cuenca
- Gastroenterology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Ares Villagrasa-Vilella
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Liver Unit, Hospital Universitario Vall de Hebrón, Barcelona, Spain
| | - Magdalena Salcedo
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Hepatology and Liver Transplantation Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Ampuero J, Lucena A, Berenguer M, Hernández-Guerra M, Molina E, Gómez-Camarero J, Valdivia C, Gómez E, Casado M, Álvarez-Navascuez C, Jorquera F, García-Buey L, Díaz-González Á, Morillas R, García-Retortillo M, Sousa JM, Pérez-Medrano I, Simón MÁ, Martínez J, Arenas J, Londoño MC, Olveira A, Fernández-Rodríguez C. Predictive factors for decompensating events in patients with cirrhosis with primary biliary cholangitis under different lines of therapy. Hepatology 2024:01515467-990000000-00788. [PMID: 38447019 DOI: 10.1097/hep.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/14/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND AND AIMS The landscape in primary biliary cholangitis (PBC) has changed with the advent of second-line treatments. However, the use of obeticholic acid (OCA) and fibrates in PBC-related cirrhosis is challenging. We assessed the impact of receiving a second-line therapy as a risk factor for decompensated cirrhosis in a real-world population with cirrhosis and PBC, and identify the predictive factors for decompensated cirrhosis in these patients. APPROACH AND RESULTS Multicenter study enrolling 388 patients with PBC-cirrhosis from the Spanish ColHai registry. Biopsy (20%), ultrasound (59%), or transient elastography (21%) defined cirrhosis, and the presence of varices and splenomegaly defined clinically significant portal hypertension (CSPH). Paris-II and PBC OCA international study of efficacy criteria determined the response to ursodeoxycholic acid (UDCA), fibrates (n=93), and OCA (n=104). The incidence of decompensated cirrhosis decreased for UDCA versus OCA or fibrates in the real-world population, but they were similar considering the propensity score-matched cohort (UDCA 3.77 vs. second-line therapy 4.5 100 persons-year, respectively), as patients on second-line therapy exhibited advanced liver disease. Consequently, GGT, albumin, platelets, clinically significant portal hypertension, and UDCA response were associated with a decompensating event. OCA response (achieved in 52% of patients) was associated with bilirubin (OR 0.21 [95% CI: 0.06-0.73]) and AST (OR 0.97 [95% CI: 0.95-0.99]), while fibrate response (achieved in 55% of patients) with AST [OR 0.96 (95% CI: 0.95-0.98]). In patients treated with OCA, drug response (sHR 0.23 [95% CI: 0.08-0.64]), diabetes (sHR 5.62 [95% CI: 2.02-15.68]), albumin (sHR 0.34 [95% CI: 0.13-0.89]), and platelets (sHR 0.99 [95% CI: 0.98-1.00]) were related to decompensation. In patients treated with fibrate, drug response (sHR 0.36 (95% CI: 0.14-0.95]), albumin (sHR 0.36 (95% CI: 0.16-0.81]), and clinically significant portal hypertension (sHR 3.70 (95% CI: 1.17-11.70]) were associated with decompensated cirrhosis. CONCLUSIONS Advanced PBC, rather than OCA and fibrates, was found to be associated with decompensating events. Therefore, biochemical and clinical variables should be considered when making decisions about the management of these drugs. Moreover, a positive response to OCA and fibrates reduced the risk of decompensation.
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Affiliation(s)
- Javier Ampuero
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
- Instituto de Biomedicina de Sevilla, Spain
- Universidad de Sevilla, Spain
- CIBERehd, Spain
| | - Ana Lucena
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Marina Berenguer
- CIBERehd, Spain
- Hepatology and Liver Transplantation Unit, IISLaFe, La Fe University Hospital, Valencia, Spain
- University of Valencia, Dept of Medicine, Valencia, Spain
| | | | | | | | - Carlos Valdivia
- CIBERehd, Spain
- Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Elena Gómez
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marta Casado
- Unidad de Aparato Digestivo, Hospital Universitario Torrecardenas, Almería, Spain
| | | | - Francisco Jorquera
- CIBERehd, Spain
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de León, León, Castilla y León, Spain
| | - Luisa García-Buey
- Gastroenterology Department, Hospital Universitario La Princesa, IIS-IP, Universidad Autónoma de Madrid, Spain
| | - Álvaro Díaz-González
- Servicio de Gastroenterología y Hepatología. Grupo de Investigación Clínica y Traslacional en Enfermedades Digestivas, Instituto de Investigación Valdecilla (IDIVAL), Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Rosa Morillas
- CIBERehd, Spain
- Liver Section, Hospital Universitari Germans Trias i Pujol, IGTP, Badalona, Spain
- Universitat Autònoma de Barcelona, Spain
| | | | - Jose M Sousa
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Indhira Pérez-Medrano
- Complexo Hospitalario Universitario de Pontevedra. Instituto de Investigación Sanitaria Galicia Sur (IISGS)
| | - Miguel Á Simón
- CIBERehd, Spain
- Servicio de Aparato Digestivo, Hospital Clínico Universitario, Zaragoza, Spain
- Instituto de Investigacion Sanitaria de Aragon (IIS Aragón), Universidad de Zaragoza, Spain
| | - Javier Martínez
- CIBERehd, Spain
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Juan Arenas
- Hospital Universitario Donostia, San Sebastián, Spain
| | - María Carlota Londoño
- CIBERehd, Spain
- Liver Unit, Hospital Clínic Barcelona, Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), University of Barcelona, Barcelona, Spain
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Díaz-González Á, Hernández-Guerra M, Pérez-Medrano I, Sapena V, Riveiro-Barciela M, Barreira-Díaz A, Gómez E, Morillas RM, Del Barrio M, Escudé L, Mateos B, Horta D, Gómez J, Conde I, Ferre-Aracil C, El Hajra I, Arencibía A, Zamora J, Fernández A, Salcedo M, Molina E, Soria A, Estévez P, López C, Álvarez-Navascúes C, García-Retortillo M, Crespo J, Londoño MC. Budesonide as first-line treatment in patients with autoimmune hepatitis seems inferior to standard predniso(lo)ne administration. Hepatology 2023; 77:1095-1105. [PMID: 36626622 DOI: 10.1097/hep.0000000000000018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/06/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND AIMS In patients with non-severe acute or chronic autoimmune hepatitis (AIH) without cirrhosis, clinical practice guidelines recommend indistinct use of prednisone or budesonide. However, budesonide is infrequently used in clinical practice. We aimed to describe its use and compare its efficacy and safety with prednisone as first-line options. APPROACH AND RESULTS This was a retrospective, multicenter study of 105 naive AIH patients treated with budesonide as the first-line drug. The control group included 276 patients treated with prednisone. Efficacy was assessed using logistic regression and validated using inverse probability of treatment weighting propensity score. The median time to biochemical response (BR) was 3.1 months in patients treated with budesonide and 4.9 months in those with prednisone. The BR rate was significantly higher in patients treated with prednisone (87% vs. 49% of patients with budesonide, p < 0.001). The probability of achieving BR, assessed using the inverse probability of treatment weighting propensity score, was significantly lower in the budesonide group (OR = 0.20; 95% CI: 0.11-0.38) at any time during follow-up, and at 6 (OR = 0.51; 95% CI: 0.29-0.89) and 12 months after starting treatment (0.41; 95% CI: 0.23-0.73). In patients with transaminases <2 × upper limit of normal, BR was similar in both treatment groups. Prednisone treatment was significantly associated with a higher risk of adverse events (24.2% vs. 15.9%, p = 0.047). CONCLUSIONS In the real-life setting, the use of budesonide as first-line treatment is low, and it is generally prescribed to patients with perceived less disease activity. Budesonide was inferior to prednisone as a first-line drug but was associated with fewer side effects.
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Affiliation(s)
- Álvaro Díaz-González
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases Group, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
| | | | - Indhira Pérez-Medrano
- Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - Víctor Sapena
- Medical Statistics Core Facility, Institut D'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Hospital Clinic Barcelona, Barcelona, Spain
| | - Mar Riveiro-Barciela
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spainand CIBERehd
| | - Ana Barreira-Díaz
- Liver Unit, Internal Medicine Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spainand CIBERehd
| | - Elena Gómez
- Servicio de Aparato Digestivo, Hospital Universitario 12 de Octubre, Madrid, España
| | - Rosa M Morillas
- Hepatology Department, Hospital Germans Trias i Pujol and Germans Trias i Pujol Research Institute, IGTP, Badalona, Department of Medicine, Universitat Autònoma de Barcelona; Centro de investigación biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd
| | - María Del Barrio
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases Group, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
| | - Laia Escudé
- Liver Unit, Hospital Clínic de Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Institut D'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Centro de investigación biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd, University of Barcelona, Barcelona, España
| | - Beatriz Mateos
- Servicio de Aparato Digestivo, Hospital Universitario Ramón y Cajal, CIBERehd, IRYCIS, Madrid, Spain
| | - Diana Horta
- Servicio de Aparato Digestivo, Hospital Universitari Mutua de Terrassa, Terrassa, España
| | - Judith Gómez
- Servicio de Aparato Digestivo, Hospital Universitario de Burgos, Burgos, España
| | - Isabel Conde
- Servicio de Aparato Digestivo, Hospital Universitari i Politècnic La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, España
| | - Carlos Ferre-Aracil
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Ismael El Hajra
- Servicio de Aparato Digestivo, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, España
| | - Ana Arencibía
- Servicio de Aparato Digestivo, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Javier Zamora
- Servicio de Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, España
| | - Ainhoa Fernández
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Magdalena Salcedo
- Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Esther Molina
- Servicio de Aparato Digestivo, Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, España
| | - Anna Soria
- Unidad de Hepatología, Servicio de Aparato Digestivo, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, España
| | - Pamela Estévez
- Servicio de Aparato Digestivo, Hospital Universitario Álvaro Cunqueiro, Vigo, España
| | - Carmen López
- Servicio de Aparato Digestivo, Hospital Universitari Josep Trueta, Girona, España
| | | | | | - Javier Crespo
- Gastroenterology and Hepatology Department, Clinical and Translational Research in Digestive Diseases Group, Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital, Santander, Spain
| | - María-Carlota Londoño
- Liver Unit, Hospital Clínic de Barcelona, Health Care Provider of the European Reference Network on Rare Liver Disorders (ERN-Liver), Institut D'Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Centro de investigación biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd, University of Barcelona, Barcelona, España
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Rodríguez-Perálvarez M, Pérez-Medrano I, Guerrero-Misas M, González V, Poyato A, Barrera P, Ferrín G, Pozo JC, Sánchez-Frías M, Ciria R, Briceño J, Montero JL, De la Mata M. Everolimus is safe within the first month after liver transplantation. Transpl Immunol 2015; 33:146-51. [PMID: 26392195 DOI: 10.1016/j.trim.2015.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 09/15/2015] [Accepted: 09/17/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Sirolimus should not be started within the first month after liver transplantation (LT) because of an increased risk of adverse outcomes. The evidence regarding everolimus is lacking but the manufacturer transposed the same warning. We aimed to evaluate the safety of everolimus started within the first month after LT. METHODS A consecutive cohort 187 LT patients (2009-2013) with a tacrolimus-based immunosuppression was evaluated. Patients starting everolimus within the first month after LT (n = 33; 17.6%) were compared with those starting everolimus thereafter (n = 25; 13.4%) or not receiving everolimus (n = 129; 69%). The median follow-up after LT was 21 months (IQR 7-36). Prospective outcomes were evaluated by using Kaplan-Meier curves and Cox's regression. RESULTS The incidence of hepatic artery thrombosis was not significantly different in patients early treated with everolimus when compared with the remaining cohort (0% vs 9.1%; p = 0.12). Other vascular complications occurred in 9.1% of patients with early everolimus vs 7.3% in the remaining cohort (p = 0.72). No wound healing complications were detected with early everolimus. There were similar rates of incisional hernia (p = 0.31), infections (p = 0.15), renal impairment (p = 0.37), and histologically-proven acute rejection (p = 0.24) between groups. The rates of hyperlipidemia were increased with early everolimus (29.9% vs 16.5% at 3 years; p = 0.018). Graft loss and mortality rates were similar between groups (p = 0.34 and p = 0.94 respectively), after adjusting for possible confounding factors. CONCLUSIONS Everolimus combined with reduced tacrolimus proved to be safe within the first month after LT. Future trials may be allowed to implement everolimus early after LT.
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Affiliation(s)
- Manuel Rodríguez-Perálvarez
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain.
| | - Indhira Pérez-Medrano
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain.
| | - Marta Guerrero-Misas
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain.
| | - Víctor González
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain.
| | - Antonio Poyato
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain.
| | - Pilar Barrera
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain.
| | - Gustavo Ferrín
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain
| | - Juan C Pozo
- Intensive Care Unit, Reina Sofía University Hospital, Córdoba, Spain.
| | | | - Rubén Ciria
- Department of General Surgery and Abdominal Transplantation, Reina Sofía University Hospital, Córdoba, Spain.
| | - Javier Briceño
- Department of General Surgery and Abdominal Transplantation, Reina Sofía University Hospital, Córdoba, Spain.
| | - José L Montero
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain.
| | - Manuel De la Mata
- Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC. CIBERehd, Córdoba, Spain.
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