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.