Liver injury after COVID-19 vaccination: Current status and future perspectives

Core Tip

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.