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

Ekpanyapong, Sirina; Bunchorntavakul, Chalermrat; Reddy, K. Rajender

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.