Outcomes of COVID-19 in Patients with Cirrhosis or Liver Transplantation

Abstract

Coronavirus disease 2019 (COVID-19) is associated with a significant morbidity and mortality in patients with cirrhosis. There is a significantly higher morbidity and mortality due to COVID-19 in patients with decompensated cirrhosis as compared to compensated cirrhosis, and in patients with cirrhosis as compared to noncirrhotic chronic liver disease. The fear of COVID-19 before or after liver transplantation has lead to a significant reduction in liver transplantation numbers, and patients with decompensated cirrhosis remain at risk of wait list mortality. The studies in liver transplantation recipients show that risk of mortality due to COVID-19 is generally driven by higher age and comorbidities. The current review discusses available literature regarding outcomes of COVID-19 in patients with cirrhosis and outcomes in liver transplant recipients.

Keywords: ACE, angiotensin-converting enzyme related carboxypeptidase receptors; ACLF, acute-on chronic liver failure; ALI, acute liver injury; ALT, alanine transaminase; AST, aspartate aminotransferase; CLD, chronic liver disease; COVID-19, Coronavirus disease 2019; HCWs, health care workers; HR, hazard ratio; LFT, liver function tests; LT, liver transplantation; MELD, model for end-stage liver disease; NAFLD, non-alcoholic fatty liver disease; NASH, non-alcoholic steatohepatitis; OR, Odds ratio; SARS-CoV-2; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; immunosuppression; liver diseases; mortality; nash.

Figure 1

Mortality in COVID-19, data based on references^, and Table 2.