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Introduction
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 …