COVID-19: Gastrointestinal manifestations, liver injury and recommendations

Table 2 European Association for the Study of the Liver-European Clinical Microbiology and Infectious Diseases recommendations for liver transplantation[48]

EASL-ECCMID recommendations
Liver transplant recipients
Reduction of immunosuppressive therapy should only be considered under special circumstances such as drug-induced lymphopenia, superinfection in case of severe COVID-19
LT recipients have high anxiety for COVID-19, and therefore their follow-up and treatment compliance may be impaired
Drug levels of calcineurin inhibitors and rapamycin inhibitors should be closely monitored. Because drugs used COVID-10 treatment such as hydroxychloroquine or protease inhibitors may interact them
Early admission should be made for LT recipients with COVID-19 infection
LT recipients, who have underlying malignancy, sarcopenia, graft dysfunction and metabolic disease are at-risk group for a severe COVID-19 infection
All patients should receive vaccination for Streptococcus pneumonia, influenza and COVID-19
Liver transplant candidates
Patients on the LT waiting list with decompensated cirrhosis are at high risk of severe COVID-19
LT should be prioritized for patients with poor short-term prognosis including those with acute liver failure, ACLF, high MELD score (including exceptional MELD points), and HCC at the upper limits of the Milan criteria
All donors for should be screening for SARS-CoV-2 infection by PCR and recommend
Both LT donors and recipients should be questioned clinical history, performed chest radiology, and SARS-CoV-2 testing
To reduce the risk of SARS-CoV-2 infection in the peri-transplantation period, protection measures should be strictly applied. Inward of high disease burden, a COVID-19 free pathway through transplantation should be implemented, including strict social isolation for waiting list patients, telephone screening for symptoms and exposures before admission, and perioperative management in a designated clean intensive care unit and post-LT ward
Consent for transplantation should include the potential risk of nosocomial COVID-19
LT candidates should be informed that infection with SARS-CoV-2 in patients undergoing major surgery is associated with an increased risk of severe COVID-19 and death
Living-donor transplantations should be considered on a case-by-case basis and include careful risk stratification of donor and recipient, incorporating a combination of clinical history, chest radiology, and SARS-CoV-2 testing

EASL: European Association for the Study of the Liver; ECCMID: European Clinical Microbiology and Infectious Diseases; LT: Liver transplantation; ACLF: Acute-on-chronic liver failure; MELD: Model for end-stage liver disease; HCC: Hepatocellular carcinoma.