Sato K. Liver injury after COVID-19 vaccination: Current status and future perspectives. World J Hepatol 2026; 18(5): 116542 [DOI: 10.4254/wjh.v18.i5.116542]
Corresponding Author of This Article
Ken Sato, MD, PhD, Professor, Department of Healthcare Informatics, Takasaki University of Health and Welfare, 37-1 Nakaorui-machi, Takasaki 370-0033, Japan. satoken@gunma-u.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
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review-article
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Sato K. Liver injury after COVID-19 vaccination: Current status and future perspectives. World J Hepatol 2026; 18(5): 116542 [DOI: 10.4254/wjh.v18.i5.116542]
World J Hepatol. May 27, 2026; 18(5): 116542 Published online May 27, 2026. doi: 10.4254/wjh.v18.i5.116542
Liver injury after COVID-19 vaccination: Current status and future perspectives
Ken Sato
Ken Sato, Department of Healthcare Informatics, Takasaki University of Health and Welfare, Takasaki 370-0033, Japan
Author contributions: Sato K designed the overall concept and contributed to the writing, editing, and revision of the manuscript, illustrations, and literature review.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Ken Sato, MD, PhD, Professor, Department of Healthcare Informatics, Takasaki University of Health and Welfare, 37-1 Nakaorui-machi, Takasaki 370-0033, Japan. satoken@gunma-u.ac.jp
Received: November 17, 2025 Revised: January 18, 2026 Accepted: March 12, 2026 Published online: May 27, 2026 Processing time: 191 Days and 19.1 Hours
Abstract
Coronavirus disease 2019 (COVID-19) vaccination has reduced the morbidity and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and has resulted in many benefits for humans. Conversely, although not frequent, hepatic injury, such as autoimmune hepatitis and drug-induced liver injury due to COVID-19 vaccination, has been observed in scattered cases. Furthermore, recent increases in the number of case series publications have progressively contributed to the understanding of the pathophysiological mechanisms, clinical management strategies, and prognostic implications associated with post-COVID-19 liver injury. Nonetheless, several critical aspects remain to be elucidated, including the optimal timing for initiating therapeutic interventions, the criteria for their discontinuation, and the clinical appropriateness of vaccine rechallenge. Here, I comprehensively review the literature concerning liver injury after COVID-19 vaccination and discuss possible measures to help prevent unexpected liver injury after COVID-19 vaccination considering the expected continued future occurrence of SARS-CoV-2 infection.
Core Tip: Liver injury following coronavirus disease 2019 vaccination presents with heterogeneous phenotypes, including new-onset autoimmune hepatitis, drug-induced autoimmune-like hepatitis, drug-induced liver injury, and secondary hepatic manifestations linked to comorbidities such as hemophagocytic lymphohistiocytosis. Vaccine-type differences in liver injury remain inconclusive. Prognosis varies by etiology; although many cases resolve spontaneously or respond to immunosuppressive therapy, some progress to acute liver failure necessitating transplantation or resulting in death. Vaccine rechallenge may not be contraindicated, but switching vaccine platforms is advised. The pathogenesis likely involves multifactorial mechanisms, such as genetic predispositions and immunological cross-reactivity between viral-specific antigens and host self-proteins.
