Coronavirus disease 2019 and the liver

Abstract

Purpose of reviewThe objective of this review is to examine the epidemiology and pathogenesis of liver injury in coronavirus disease 2019 (COVID-19) and the impact of COVID-19 on patients with chronic liver disease (CLD) and liver transplant recipients.Recent findingsAbnormal liver chemistries occur in up to 60% of COVID-19 patients and are typically mild. COVID-19- associated liver injury may be because of direct viral cytopathic effect, immune-mediated damage, hypoxia, drug-induced liver injury (DILI), or exacerbation of CLD. COVID-19 patients with CLD and who are liver transplant recipients are at risk for severe disease and mortality. COVID-19 precipitated hepatic decompensation in 20–46% of cirrhotic patients. Alcohol consumption and cases of acute alcohol- associated hepatitis increased during the COVID-19 pandemic. Corticosteroids and calcineurin inhibitors are well tolerated to use during COVID-19 but immunomodulators have been associated with mortality. Less than 50% of transplant recipients produce adequate antibody titers after COVID-19 vaccination.SummaryCOVID-19 patients with CLD should be monitored for liver injury and hepatic decompensation. Patients with CLD and liver transplant recipients should be considered for targeted COVID-19 pharmacotherapeutics and advised vaccination against COVID-19, including a third booster dose. CLD treatments and immunosuppression in liver transplant recipients could generally continue without interruption during COVID-19 infection, with the possible exception of immunomodulators.

SARS-CoV-2 induced liver injury: Incidence, risk factors, impact on COVID-19 severity and prognosis in different population groups

“…These differences could be attributed to the nature of the studies that were included and the various outcomes definitions[ 207 , 208 ]. It seems that LI portends the need for ICU care and IMV[ 209 ]. CLD is also associated with severity [odds ratio (OR)/relative risk (RR) = 1.48, 1.70][ 208 , 210 - 213 ], and mortality (OR/RR = 1.08, 2.65)[ 208 , 212 , 214 ] while in a few studies such an association was not observed[ 6 , 207 , 215 - 219 ] (Table 1 ).…”

“…CAID is also associated with increased serum levels of IL-1β, -6, -17, -18, TNF-α, and IFN-γ[ 245 ], and predisposes to a variety of viral or fungal-related diseases[ 246 ]. Despite the increased risk of infection[ 247 ], cirrhotics exhibit a lower risk of acquiring SARS-CoV-2[ 209 , 248 , 249 ], whereas in large population studies patients with CLD are not over-represented[ 250 ]. In patients with CLD, a condition known as acute-on-chronic liver failure (ACLF) is characterized by abrupt hepatic decompensation and extrahepatic organ failures and is linked with a significant short-term mortality[ 251 ].…”

“…COVID-19 is linked to worse postoperative transplant outcomes, particularly in elderly and obese patients[ 294 ]. Most LT patients with COVID-19[ 295 , 209 ] should continue to receive systemic immunosuppression with stable dosages, except for immunomodulators[ 209 ], as mycophenolate treatment is considered an independent risk factor for severe COVID-19[ 289 ]. The case-fatality rates (17%-18%) are consistent with the expected mortality rates[ 296 ].…”

Impact of COVID‐19 on abdominal organ transplantation: A bibliometric analysis

“…Cases of abdominal solid organ transplant (SOT) patients affected by COVID‐19 were reported days later 2 . Organ transplantation has been significantly impacted by the COVID‐19 pandemic, with kidney transplantation and living donor programs bearing the brunt of this impact 3–6 . The tightening and easing of restrictions in response to “waves” of infection and the appearance of COVID‐19 variations over the course of 2 years have posed unique challenges for waitlisted patients, transplant recipients, and transplant programs 6 .…”