WGO Guidance for the Care of Patients With COVID-19 and Liver Disease
- PMID: 33230011
- PMCID: PMC7713641
- DOI: 10.1097/MCG.0000000000001459
WGO Guidance for the Care of Patients With COVID-19 and Liver Disease
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the least deadly but most infectious coronavirus strain transmitted from wild animals. It may affect many organ systems. Aim of the current guideline is to delineate the effects of SARS-CoV-2 on the liver. Asymptomatic aminotransferase elevations are common in coronavirus disease 2019 (COVID-19) disease. Its pathogenesis may be multifactorial. It may involve primary liver injury and indirect effects such as "bystander hepatitis," myositis, toxic liver injury, hypoxia, and preexisting liver disease. Higher aminotransferase elevations, lower albumin, and platelets have been reported in severe compared with mild COVID-19. Despite the dominance of respiratory disease, acute on chronic liver disease/acute hepatic decompensation have been reported in patients with COVID-19 and preexisting liver disease, in particular cirrhosis. Metabolic dysfunction-associated fatty liver disease (MAFLD) has a higher risk of respiratory disease progression than those without MAFLD. Alcohol-associated liver disease may be severely affected by COVID-19-such patients frequently have comorbidities including metabolic syndrome and smoking-induced chronic lung disease. World Gastroenterology Organization (WGO) recommends that interventional procedures such as endoscopy and endoscopic retrograde cholangiopancreatography should be performed in emergency cases or when they are considered strictly necessary such as high risk varices or cholangitis. Hepatocellular cancer surveillance may be postponed by 2 to 3 months. A short delay in treatment initiation and non-surgical approaches should be considered. Liver transplantation should be restricted to patients with high MELD scores, acute liver failure and hepatocellular cancer within Milan criteria. Donors and recipients should be tested for SARS-CoV-2 and if found positive donors should be excluded and liver transplantation postponed until recovery from infection.
Conflict of interest statement
The authors declare that they have nothing to disclose.
Comment in
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Comments on the "WGO Guidance for the Care of Patients With COVID-19 and Liver Disease".J Clin Gastroenterol. 2021 Aug 1;55(7):638. doi: 10.1097/MCG.0000000000001508. J Clin Gastroenterol. 2021. PMID: 34227618 Free PMC article. No abstract available.
References
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- Organization WH. MERS situation update, January 2020. Available at: http://www.emro.who.int/health-topics/mers-cov/mersoutbreaks. html Accesesd February 29, 2020.
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