ALEXANDRIA,VA – The American Association for the Study of Liver Disease (AASLD) has released a clinical insight document for clinicians and frontline healthcare providers who are treating patients with liver disease during the COVID-19 pandemic. The document, which cites recent studies conducted in China, assesses how hepatologists and liver transplant physicians/surgeons and their patients may be affected by the COVID-19 virus (also known as SARS-CoV-2) and provides continued guidance on clinical approaches to disease management.
“Our current understanding points to the fact that patients with cirrhosis, autoimmune hepatitis on immunosuppressive medications and pre- and post-transplant patients on immunosuppression may be among the most vulnerable patients who are at high risk of severe illness if they become infected with SARS-CoV-2,” says Raymond T. Chung, MD, FAASLD, AASLD president-elect and member of AASLD’s COVID-19 Working Group. “Hepatologists and liver transplant programs in the US can help their patients, programs, hospitals and local communities by immediately implementing containment and mitigation policies that limit non-essential patient visits to clinics and hospital.”
The document highlights what is known about how COVID-19 affects the hepatobiliary system, including:
- Incidence of elevated liver biochemistries (mainly abnormal AST and ALT, slightly elevated bilirubin) ranges from 14.8-53% in COVID-19 patients.
- Liver injury is more common in more severe cases than in mild cases.
- Liver damage in mild cases is usually transient and does not require specific treatment.
- Low albumin is a marker of disease severity.
- SARS-CoV-2 uses ACE2 to gain entry into cells (same as SARS-CoV, which caused SARS in 2002-2003).
Also highlighted are some of the known issues clinicians should be aware of with regard to different treatment approaches for COVID-19. Studies cited in the document report that drugs taken to manage symptomatic COVID-19 may be hepatotoxic, including remdesivir and tocilizumab.
To prepare clinicians and frontline health care providers, the document also provides recommendations for approaching COVID-19 in different liver disease states, including, but not limited to, hepatocellular carcinoma (HCC), cirrhosis and post-liver transplant management.
Citing reports of health care worker infection rates as high as 20 percent, the document also offers guidance for protecting health care workers and best practices for workforce utilization. “In addition to protecting our patients and communities, we must protect our healthcare workers. If we do not contain the spread of the virus quickly, the capacity of our healthcare system will be overwhelmed, including availability of ICU beds, ventilators and healthcare workers,” explains Jorge A. Bezerra, MD, FAASLD, AASLD president and member of AASLD’s COVID-19 Working Group.
The full document and additional resources can be found at aasld.org/COVID19. The document will be updated regularly as new information becomes available.
About the AASLD
AASLD is the leading organization of clinicians and researchers committed to preventing and curing liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.
For questions or interview requests, please contact the AASLD media team at media@aasld.org
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