Liver injury—expressed as elevated liver enzymes—is common in patients with COVID-19. Little is known about the potential mechanisms of liver damage by SARS-CoV-2. A direct cytopathic effect on hepatocytes as well as injury related to hypoxia or hepatotoxicity are being considered. The aim of the study was to compare the clinical characteristic of COVID-19 disease in patients with normal and abnormal liver enzymes activity. A group of 150 patients with COVID-19, hospitalized in our center, was analyzed. Patients with the known liver comorbidities were excluded (n = 15). Clinical features and laboratory parameters were compared between patients with normal and abnormal aminotransferase values. Liver injury expressed as any alanine aminotransferase (ALT) elevation was noted in 45.6% of patients hospitalized due to COVID-19. The frequencies of aspartate aminotransferase (AST) elevation were lower. It was noted that elevated ALT/AST unfavorably affected other parameters related to liver function such as albumin level; gamma-glutamyl transpeptidase (GGTP); and partly, ALP activity and influenced inflammation-related parameters. The most probable cause of mild hepatitis during COVID-19 was anoxia and immune-mediated damage due to the inflammatory response following SARS-CoV-2 infection. A direct cytopathic effect of SARS-CoV-2 on hepatocytes, albeit less probable, can be considered as well. The use of potentially hepatotoxic drugs may contribute to liver damage.

BackgroundAlcoholic cirrhosis is an indication for 40% of liver transplantations (LT) in Europe. In most centers, 6 months of abstinence is required before listing. However, alcohol recidivism is quite high after LT, and approximately 20–25% of recipients with ALD resume harmful drinking, resulting in liver insufficiency, which casts doubt on the 6-months rule as a reliable marker of abstinence maintenance after LT.Material/MethodsWe analyzed data on patients who underwent orthotopic LT in Marie Curie Hospital, Szczecin, Poland, from 2000 to 2015 due to alcoholic or cryptogenic cirrhosis. Every ALD patient met the 6-month abstinence requirement. Alcohol recidivism has been studied based on a history of alcohol abuse taken from the patients or from their relatives, and in case of denial, on laboratory tests for alcohol abuse. Five patterns of recidivism were distinguished: death, constant heavy drinking, heavy drinking with abstinence attempts, occasional laps, and a single episode of alcohol intake. The analysis of survival was performed according to the Kaplan-Meier method. Patient survival rates in ALD recipients vs. non-ALD recipients were compared using the log-rank test.ResultsAlcohol recidivism was finally evaluated in 109 patients: 81 males and 28 females, with a median age of 53.3 years (range 30–66). Harmful drinking was discovered in 16 patients (14.7%), including seven deaths due to alcoholic hepatitis. Sporadic or episodic drinking was found in 29 patients (27%). In heavy drinkers, the abstinence period after transplantation was significantly shorter and patients were younger than the average (median age 43.8 years). Women break abstinence faster than men and are at greater risk of liver insufficiency. Five, 10 and 15-year survival in the ALD group was superior in comparison with non-ALD group, but differences did not reach statistical significance (p=0.066, p=0.063, p=0.075, respectively).ConclusionsThe prognostic value of a 6-month abstinence period before transplantation is rather low as it does not predict sobriety after transplantation. However, only a minority of such patients drink harmfully. Survival in ALD recipients tends to be better in comparison with survival in the other etiologies. Younger women dependent on alcohol shortly before LT are at greatest risk of recidivism.

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Background: Vitamin D deficiency can cause many health problems and higher mortality. Chronic liver disease impairs vitamin D status by various mechanisms. The aim of our study was to estimate and directly compare vitamin D status in liver recipients before and within six months after LT to see whether there is an impact of restoration of proper liver function on 25(OH)D concentration.Patients and methods: Serum 25(OH)D concentration was determined and compared in the group of 110 adult patients before and within six months after LT. Measures performed right before transplantation were related to the etiology of liver disease, stage of cirrhosis and a season when the examination was done. 25(OH)D in the study group was also compared to the vitamin D concentration in the control group of 110 healthy persons matching the patients with respect to the age (p = 0.16), sex (p = 0.18) and body weight (p = 0.12). 25(OH)D concentration below 20 ng/mL was considered deficient, between 20 and 30 ng/ mL insufficient and > 30 ng/mL sufficient. Frequencies of some clinical episodes like fractures, infections, deaths and diabetes mellitus were compared between groups.Results: 25(OH)D concentration was significantly higher in the study group compared to the control group (20.83 + 13.48 vs. 14.8 + 8.39, p = 0.0001). There was a significant impact of summer-autumn season on better 25(OH)D concentration both in the study group and in the controls. The lowest concentration of vitamin D in the study group before LT was noted in alcoholic liver disease compared to the other etiologies (15.56 + 10.42 vs. 23.61 + 14.13, p = 0.002). The mean 25(OH)D concentration in the study group significantly improved after LT (27.37 + 12.5 vs. 20.83 + 13.48, p = 0.00001), but still more than 50% of recipients were significantly deficient. Conclusions:Vitamin D deficiency is ubiquitous. Liver insufficiency does not have much impact on vitamin D status. Patients with chronic liver disease as well as healthy subjects require regular vitamin D monitoring and supplementation when appropriate. Patients with alcoholic liver cirrhosis and the end-stage disease are in a special need. After LT concentration of vitamin D improves, but more than 50% of the recipients require either proper prophylaxis or treatment.

A 14 year-old previously healthy female patient presented with back pain, halitosis, and hemoccult positive stool.She was ultimately diagnosed with Takayasu’s Vasculitis and thrombo-angiitis vasculitis as well as a post-mortemdiagnosis of Hepatitis C. The two vasculitides created a pulmonary arterial-esophageal fistula with a necrotic areaand a ruptured pulmonary artery, which led to the patient’s death. Further discussion with the familyindicated thatthey were unaware of the patient’s Hepatitis C status and they denied any risk factors the patient may have had thatlead to Hepatitis C infection. Obtaining a history in pediatric patients is often limited by what the family knows anddiscloses, but when a patient presents with elevated inflammatory markers, halitosis, and hemoccult-positive stool,an esophageal fistula should be considered in one’s differential diagnosis.