Coronavirus disease 2019 and the liver

Area of Science:

• Hepatology
• Infectious Diseases
• Immunology

Background:

• Coronavirus disease 2019 (COVID-19) is associated with liver injury in a significant percentage of patients.
• Liver injury in COVID-19 may stem from direct viral effects, immune responses, hypoxia, drug toxicity, or worsening of existing chronic liver disease (CLD).
• Patients with CLD and liver transplant recipients are at increased risk for severe COVID-19 outcomes and mortality.

Purpose of the Study:

• To review the epidemiology and pathogenesis of liver injury in COVID-19.
• To assess the impact of COVID-19 on patients with CLD.
• To evaluate the effects of COVID-19 on liver transplant recipients.

Main Methods:

• Systematic review of existing literature on COVID-19 and liver disease.
• Analysis of epidemiological data and clinical outcomes.
• Evaluation of treatment strategies and vaccination responses.

Main Results:

• Abnormal liver chemistries are common in COVID-19 patients, usually mild.
• COVID-19 can precipitate hepatic decompensation in 20-46% of patients with cirrhosis.
• Alcohol-related liver disease cases increased during the pandemic.
• Certain immunosuppressants may increase mortality risk in COVID-19 patients.
• Fewer than 50% of liver transplant recipients achieve adequate antibody titers post-COVID-19 vaccination.

Conclusions:

• COVID-19 patients with CLD require close monitoring for liver injury and decompensation.
• Targeted pharmacotherapeutics and COVID-19 vaccination, including boosters, are recommended for patients with CLD and transplant recipients.
• Standard CLD treatments and immunosuppression for transplant recipients can generally continue, with caution regarding immunomodulators.