Opinion Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 27, 2021; 13(5): 522-532
Published online May 27, 2021. doi: 10.4254/wjh.v13.i5.522
COVID-19 and the liver: What do we know so far?
Prashant Nasa, George Alexander
Prashant Nasa, Department of Critical Care Medicine, NMC Specialty Hospital, Dubai 7832, United Arab Emirates
George Alexander, Department of Gastroenterology, Mediclinic Welcare Hospital, Dubai 0000, United Arab Emirates
George Alexander, Department of Gastroenterology, Mediclinic Deira, Dubai 0000, United Arab Emirates
Author contributions: Nasa P and Alexander G contributed equally to this work; Nasa P and Alexander G designed the research study; Nasa P and Alexander G searched and reviewed the literature; Nasa P conceptualized and designed the figure; All authors have read and approved the final manuscript.
Conflict-of-interest statement: Prashant Nasa has received fees for serving as an advisory board member to Edward Lifesciences.
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 Non Commercial (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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Prashant Nasa, MD, Chief Doctor, Department of Critical Care Medicine, NMC Specialty Hospital, Amman Street, Al Nahda 2, Dubai 7832, United Arab Emirates. dr.prashantnasa@hotmail.com
Received: March 7, 2021
Peer-review started: March 7, 2021
First decision: March 29, 2021
Revised: March 30, 2021
Accepted: April 29, 2021
Article in press: April 29, 2021
Published online: May 27, 2021

The coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on public health and healthcare. The pandemic surge and resultant lockdown have affected the standard-of-care of many medical conditions and diseases. The initial uncertainty and fear of cross transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have changed the routine management of patients with pre-existing liver diseases, hepatocellular carcinoma, and patients either listed for or received a liver transplant. COVID-19 is best described as a multisystem disease caused by SARS-CoV-2, and it can cause acute liver injury or decompensation of the pre-existing liver disease. There has been considerable research on the pathophysiology, infection transmission, and treatment of COVID-19 in the last few months. The pathogenesis of liver involvement in COVID-19 includes viral cytotoxicity, the secondary effect of immune dysregulation, hypoxia resulting from respiratory failure, ischemic damage caused by vascular endotheliitis, congestion because of right heart failure, or drug-induced liver injury. Patients with chronic liver diseases, cirrhosis, and hepatocellular carcinoma are at high risk for severe COVID-19 and mortality. The phase III trials of recently approved vaccines for SARS-CoV-2 did not include enough patients with pre-existing liver diseases and excluded immunocompromised patients or those on immunomodulators. This article reviews the currently published research on the effect of COVID-19 on the liver and the management of patients with pre-existing liver disease, including SARS-CoV-2 vaccines.

Keywords: COVID-19, Chronic liver disease, SARS-CoV-2, Severe acute respiratory syndrome coronavirus, Liver transplant, Liver and SARS-CoV-2 vaccines, SARS-CoV-2 induced liver injury

Core Tip: Liver involvement in coronavirus disease 2019 (COVID-19) is caused by either viral cytotoxicity or secondary to systemic immune dysregulation. Patients with pre-existing liver disease are at high risk of disease progression, morbidity, and mortality. Chronic liver disease with COVID-19 should be managed as per the standard guidelines, with education on hand hygiene, social distancing, and face masks to reduce hospital admissions. There is no evidence that currently available vaccines for severe acute respiratory syndrome coronavirus 2 will have any complications different from other inactivated vaccines and are recommended for patients with pre-existing liver disease, hepatocellular carcinoma, or liver transplant recipients.