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COVID-19 and liver disease
  1. Jean-François Dufour1,
  2. Thomas Marjot2,3,
  3. Chiara Becchetti4,5,
  4. Herbert Tilg6
  1. 1 Hepatology, Department of Biomedical Research, University of Bern, Bern, Switzerland
  2. 2 Oxford Liver Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
  3. 3 Nuffield Department of Medicine, Translational Gastroenterology Unit, University of Oxford, Oxford, UK
  4. 4 Department of Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Bern, Italy
  5. 5 Department of Visceral Surgery and Medicine, Inselspital, University Hospital of Bern, Bern, Switzerland
  6. 6 Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism, Medical University Innsbruck, Innsbruck, Austria
  1. Correspondence to Professor Jean-François Dufour, University of Bern, Bern 3012, Switzerland; jf.dufour{at}


Knowledge on SARS-CoV-2 infection and its resultant COVID-19 in liver diseases has rapidly increased during the pandemic. Hereby, we review COVID-19 liver manifestations and pathophysiological aspects related to SARS-CoV-2 infection in patients without liver disease as well as the impact of COVID-19 in patients with chronic liver disease (CLD), particularly cirrhosis and liver transplantation (LT). SARS-CoV-2 infection has been associated with overt proinflammatory cytokine profile, which probably contributes substantially to the observed early and late liver abnormalities. CLD, particularly decompensated cirrhosis, should be regarded as a risk factor for severe COVID-19 and death. LT was impacted during the pandemic, mainly due to concerns regarding donation and infection in recipients. However, LT did not represent a risk factor per se of worse outcome. Even though scarce, data regarding COVID-19 specific therapy in special populations such as LT recipients seem promising. COVID-19 vaccine-induced immunity seems impaired in CLD and LT recipients, advocating for a revised schedule of vaccine administration in this population.

  • COVID-19
  • cirrhosis
  • liver transplantation

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  • Contributors Each author wrote a part of the manuscript. All authors reviewed/edited the whole paper several times.

  • Funding TM receives funding via a Wellcome Trust Clinical Research Training Fellowship (reference number: 102176/B/13/Z) and has received registry grant funding from the European Association for the Study of the Liver (EASL) (reference number: 2020RG03). HT is supported by the excellence initiative VASCage (Centre for Promoting Vascular Health in the Ageing Community), an R&D K-Centre (COMET programme (Competence Centers for Excellent Technologies)) funded by the Austrian Ministry for Transport, Innovation and Technology, the Austrian Ministry for Digital and Economic Affairs and the federal states Tyrol, Salzburg and Vienna.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.