Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2021; 13(10): 1367-1377
Published online Oct 27, 2021. doi: 10.4254/wjh.v13.i10.1367
Liver and COVID-19: From care of patients with liver diseases to liver injury
Rui Gaspar, Catarina Castelo Branco, Guilherme Macedo
Rui Gaspar, Guilherme Macedo, Department of Gastroenterology and Hepatology, Centro Hospitalar de São João, Porto 4200, Portugal
Catarina Castelo Branco, Department of Internal Medicine, Centro Hospitalar e Universitário do Porto, Porto 4100, Portugal
Author contributions: Gaspar R and Branco CC were responsible for acquisition and interpretation of data and drafting of the manuscript; and Macedo G was responsible for critical revision of the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Rui Gaspar, MD, Doctor, Department of Gastroenterology and Hepatology, Centro Hospitalar de São João, Alameda Prof Hernani Monteiro, Porto 4200, Portugal.
Received: May 28, 2021
Peer-review started: May 28, 2021
First decision: June 27, 2021
Revised: July 11, 2021
Accepted: August 31, 2021
Article in press: August 31, 2021
Published online: October 27, 2021

The global pandemic of coronavirus disease 2019 (COVID-19) changed dramatically all priorities on medical society and created several challenges for clinicians caring for patients with liver diseases. We performed a comprehensive review about how COVID-19 can affect the liver, the influence of liver diseases on the risk of developing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19 severity and also some strategies to overcome all the challenges clinicians have to face in the management of patients with liver diseases in a period of time when all the focus turned on COVID-19. We analyze the relationship between COVID-19 and non-alcoholic fatty liver disease, alcoholic liver disease, viral hepatitis, autoimmune liver disease, cirrhosis, hepatocellular carcinoma and liver transplantation, as well as the approach to SARS-CoV-2 vaccination.

Keywords: COVID-19, Liver diseases, Vaccination, SARS-CoV-2

Core Tip: Coronavirus disease 2019 (COVID-19) has become a major health problem worldwide in the last few months, affecting the health system dramatically. Apart from the respiratory system, associated liver injury is one of the main concerns in severe acute respiratory syndrome coronavirus 2 infection and several mechanisms could explain liver abnormalities. In this mini-review, and different from other papers, we not only analyze liver injury by COVID-19, the effect of COVID-19 in liver diseases, its pathophysiology and strategies to keep an adequate care of liver patients, but also highlight the potential higher risk of severe disease or risk of infection in patients with different etiologies of liver disease. We also analyze the recent recommendations and prioritization regarding vaccination in patients with liver disease.