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Review
. 2022 Jan;29(1):4-20.
doi: 10.1111/jvh.13590. Epub 2021 Aug 12.

COVID-19 and the Liver: Lessons Learnt from the EAST and the WEST, A Year Later

Sirina Ekpanyapong  1 , Chalermrat Bunchorntavakul  1 , K Rajender Reddy  2
Affiliations
Review

COVID-19 and the Liver: Lessons Learnt from the EAST and the WEST, A Year Later

Sirina Ekpanyapong et al. J Viral Hepat. 2022 Jan.

Abstract

Globally, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) has been a major cause for significant morbidity and mortality. Since the start of the pandemic, several hepato-biliary manifestations in coronavirus disease 2019 (COVID-19) have been described and unique considerations raised. The review aims to summarize the pathogenesis and hepato-biliary manifestations in COVID-19 and discuss the similarities, contrasting features and disease-specific management across a range of hepato-biliary diseases from the EAST and the WEST. Published studies and regional society guidelines from the EAST and the WEST were comprehensively reviewed and summarized. A wide range of hepato-biliary manifestations, including the infrequent and chronic manifestation of cholangiopathy, has been observed in COVID-19. The pathogenesis of liver injury is multifactorial and with scant evidence for a direct SARS-CoV-2 infection of the liver. Patients with non-alcoholic fatty liver disease, cirrhosis, and liver cancer are potentially at increased risk for severe COVID-19, and there are unique considerations in chronic hepatitis B or C, hepatocellular carcinoma, and in those immunosuppressed such as autoimmune hepatitis or liver transplant recipients. With the surges in SARS-CoV-2 infection, liver transplant activity has variably been impacted. Preliminarily, SARS-CoV-2 vaccines appear to be safe in those with chronic liver disease and in transplant recipients, while emerging data suggest the need for a third dose in immunosuppressed patients. In conclusion, patients with chronic liver disease, particularly cirrhosis, and liver transplant recipients, are vulnerable to severe COVID-19. Over the past year, several unique considerations have been highlighted across a spectrum of hepato-biliary diseases. Vaccination is strongly recommended for those with chronic liver disease and liver transplant recipients.

Keywords: COVID-19; cirrhosis; hepatitis; liver transplant; vaccination.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Proposed pathogenesis of hepatic manifestations in COVID‐19
FIGURE 2
FIGURE 2
Management consideration of chronic liver disease and cirrhosis during COVID‐19 era
See this image and copyright information in PMC

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