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One world, one pandemic, many guidelines: management of liver diseases during COVID-19
  1. Steven Bollipo1,2,
  2. Devika Kapuria3,
  3. Atoosa Rabiee4,
  4. Gil Ben-Yakov5,
  5. Rashid N Lui6,
  6. Hye Won Lee7,
  7. Goutham Kumar8,
  8. Keith Siau9,
  9. Juan Turnes10,
  10. Renumathy Dhanasekaran11
  1. 1 School of Medicine & Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
  2. 2 Department of Gastroenterology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
  3. 3 Gastroenterology, University of New Mexico, Albuquerque, New Mexico, USA
  4. 4 Department of Veterans Affairs, Washington, District of Columbia, USA
  5. 5 The Center for Liver Diseases, Sheba Medical Center, Tel Hashomer, Israel
  6. 6 Institute of Digestive Disease, Chinese University of Hong Kong, New Territories, Hong Kong
  7. 7 Department of Internal Medicine, Yonsei University College of Medicine, Seodaemun-gu, Korea (the Republic of)
  8. 8 Hepatobiliary Surgery & Liver Transplantation, Manipal Hospitals, Bangalore, Karnataka, India
  9. 9 Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, Birmingham, UK
  10. 10 Department of Digestive Diseases, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
  11. 11 Division of Gastroenterology and Hepatology, School of Medicine, Stanford University, Palo alto, California, USA
  1. Correspondence to Dr Steven Bollipo, The University of Newcastle, Callaghan, NSW 2308, Australia; steven.bollipo{at}

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the current global pandemic of COVID-19, which is associated with significant morbidity and mortality.1 As of 26 April 2020, it has infected over three million people worldwide and caused more than 200 000 deaths.2 Chronic liver diseases from HCV, HBV, alcoholism or non-alcoholic fatty liver disease (NAFLD) represent a major disease burden in the world. Around 1.5 billion people have chronic liver diseases worldwide, and it causes around two million deaths per year. While self-resolving elevations of transaminases are reported in 15%–54% of patients with COVID-19, those with more severe disease experience worse liver injury.3–5 An open international registry, SECURE-Cirrhosis, is reporting a mortality rate of 40% among the 118 patients with cirrhosis.6 Thus, patients with chronic liver disease represent a vulnerable population who are at higher risk of acquiring COVID-19 and suffering from its complications.7 8

International societies, including the American Association for the Study of Liver Diseases (AASLD),9 the European Association for the Study of the Liver (EASL),10 the International Liver Cancer Association (ILCA),11 the Gastroenterological Society of Australia, The Transplantation Society (TTS),12 the American Society of Transplantation Surgeons,13 and the Liver Transplant Society of India,14 have released guidance to aid physicians taking care of patients with chronic liver diseases and liver transplantation. Most of these recommendations are based on expert consensus, as rigorous data are not yet available. We compare these major international recommendations and discuss a consolidated approach to managing liver disease in the setting of COVID-19. We also share our views on the path towards the eventual transition back to normality.

Recommendations for inpatient care of chronic liver disease during COVID-19

Patients with liver diseases continue to require hospitalisation during the pandemic both for COVID-related and liver-related indications, and attempts should be made to …

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  • Twitter @stevenbollipo, @kapuriamd, @RashidLui, @renumathyd

  • Contributors All authors have contributed to this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement There are no data in this work.