What Has the COVID-19 Pandemic Taught Us so Far? Addressing the Problem from a Hepatologist’s Perspective

Méndez-Sánchez, Nahum; Valencia-Rodríguez, Alejandro; Qi, Xingshun; Yoshida, Eric M.; Romero-Gómez, Manuel; George, Jacob; Eslam, Mohammed; Abenavoli, Ludovico; Xie, Weifen; Teschke, Rolf; Carrion, Andres F.; Keaveny, Andrew P.

Patients with cholestatic diseases are another group that could present with more liver injury in the context of COVID-19 illness, as ACE2 is expressed in the epithelial cells of bile ducts. Moreover, immunocompromised states, such as those of individuals with cirrhosis and on immunosuppressive therapy, may place the patient at higher risk of severe illness. It has therefore been suggested that COVID-19 could accelerate the onset of complications in patients with compensated cirrhosis. 22 To date, we are uncertain about the effects of immunosuppression in these patients and in post-transplant liver patients. During previous outbreaks of coronavirus infections, it was suggested that immunocompromised patients (adults and children) are not at increased risk of infection compared to the general population. 23 However, if this pandemic has taught us anything, it is that the knowledge from previous experiences may not be generalizable to this new infection. A recent case report described a perioperative presentation of COVID-19 in a liver transplant recipient that jeopardized the graft. 24 The groups of people who need to take extra precautions may expand as we learn more about SARS-CoV-2.