Management of COVID-19 patients with chronic liver diseases and liver transplants

Abstract

The epidemic of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has increasingly attracted worldwide concern. Liver damage or dysfunction occurred in patients with COVID-19 (mainly characterized by moderately elevated serum aspartate aminotransferase levels). However, it is not yet clear whether the COVID-19-related liver injury is mainly caused by the virus infection, potentially hepatotoxic drugs, or other coexisting conditions. Progression of pre-existing chronic liver disease (CLD) may be the underlying mechanism of liver injury. Although COVID-19 patients with CLD, such as nonalcoholic fatty liver disease, liver cirrhosis, and liver cancer, have been deemed at increased risk for serious illness in many studies, little is known about the impact of CLD on the natural history and outcome of COVID-19 patients. Thereby, based on the latest evidence from case reports and case series, this paper discusses the clinical manifestations, treatment, prognosis, and management of the COVID-19 patients with different CLD. This article also reviews the effect of COVID-19 on liver transplantation patients (LT), hoping to work for future prevention, management, and control measures of COVID-19. However, due to the lack of relevant research, most of them are still limited to the theoretical stage, further study of COVID-19 and CLD needs to be improved in the future.

Remdesivir use and risks of acute kidney injury and acute liver injury among patients hospitalised with COVID‐19: a self‐controlled case series study

“…If the potential benefits of remdesivir initiation would outweigh the risks, this antiviral treatment should not be precluded. 53 , 55 …”

“…Therefore, the elevation of liver enzymes during the course of COVID‐19 was not solely attributable to the administration of remdesivir. If the potential benefits of remdesivir initiation would outweigh the risks, this antiviral treatment should not be precluded 53,55 …”

Liver injury in COVID-19 patients with non-alcoholic fatty liver disease: an update

“…NAFLD is the most common chronic liver disease in the world [14], and it is hypothesized to be present in the majority of COVID-19 patients with pre-existing CLD worldwide [94].…”

S1-Leitlinie zur Versorgung von Lebertransplantierten während der COVID-19-Pandemie – AWMF-Registernummer: 021-031 – Stand 15. Juni 2022

“…Entsprechend den Empfehlungen bei Patienten mit Autoimmunerkrankungen wäre bei niedrigen Titern (allgemein gültige Titer-Grenzwerte sind aktuell aber nicht definiert und variieren möglicherweise zwischen Test-Systemen), eine erneute Auffrischungsimpfung zu erwägen 46 . Unabhängige Risikofaktoren für ein fehlendes Impfansprechen sind insbesondere männliches Geschlecht, höheres Alter, Niereninsuffizienz und Immunsuppression 10 40 41 42 43 44 45 .…”

“…Eine Impfung gegen SARS-CoV-2 wird für Patienten mit Leberzirrhose sowohl von der STIKO [39] als auch den Leitlinien der europäischen und amerikanischen Fachgesellschaften empfohlen [33,40]. Inzwischen liegen auch Daten zur Sicherheit und Wirksamkeit bei diesen Patienten vor, die belegen, dass vergleichbar zu anderen Impfungen, das Impfansprechen [10,[40][41][42][43][44][45] bei Leberzirrhose eingeschränkt ist. Da in bis zu 30 % der Fälle keine Antikörper gegen SARS-CoV-2 nachgewiesen werden können [11], erscheint eine Antikörper-Titer-Testung im Verlauf nach erfolgter Impfung gerechtfertigt.…”