Advanced liver disease patients and transplant recipients need specific care during COVID-19

Currently, there are limited data on the impact of pre-existing liver disease and the course of SARS-CoV-2 infection, with many open questions.

However, patients with advanced liver disease and recipients of liver transplants represent vulnerable groups and are likely to be at an increased risk of infection and/or a severe course of COVID-19. In addition, the COVID-19 pandemic is placing an increasing burden on healthcare systems across the world, which could negatively impact the care of patients with chronic liver diseases who require ongoing medical attention.

To promote the best possible care in these challenging circumstances, this Position Paper provides recommendations for clinicians treating patients with chronic liver diseases.

Recommendations include: promoting telemedicine in the outpatient setting, prioritising outpatient contacts, and avoiding nosocomial dissemination of the virus to patients and healthcare providers while maintaining standard care for patients who require immediate medical attention. Additionally, the paper includes a flowchart on prioritising patient care in patients with chronic liver disease.

"While the threat COVID-19 poses to our populations is clear, it remains vital to maintain appropriate care for patients with chronic liver disease. Clinicians will need to identify ways to prioritise their care even when healthcare resources are limited. EASL has therefore published this joint Position Paper to help support clinicians facing these difficult challenges," said Prof. Phil Newsome, Secretary General of the European Association for the Study of Liver Disease (EASL) and Director of the Centre for Liver and Gastrointestinal Research & Professor of Hepatology at the University of Birmingham, UK.

The paper provides recommendations on the use of outpatient care, ways to reduce direct exposure to COVID-19, and advice on managing patients with compensated/decompensated liver disease, with hepatocellular carcinoma, and following liver transplantation. It also includes advice on liver-related diagnostic procedures (including endoscopy, ultrasound, and liver biopsy), on the collaboration with local healthcare providers and primary care physicians, and on inpatient care and treatments currently being suggested.

"These recommendations address the specific concerns of patients with liver disease and are meant to provide additional guidance for their care. It is important to stress that all general recommendations and guidelines with regards to prevention, diagnosis and treatment of COVID-19 from local authorities must be adhered to," said Prof. Thomas Berg, Vice-Secretary General of EASL and Head of the Section of Hepatology Acting Director of the Clinic of Gastroenterology, University Hospital Leipzig, Germany.

"This joint Position Paper is a major EASL-ESCMID collaborative effort on management of liver disease during the COVID-19 pandemic strengthening links between our societies," said co-author and ESCMID Fellow Prof. Mario Mondelli, Professor of Infectious Diseases, University of Pavia, Clinical Lead, Division of Infectious Diseases and Immunology, Fondazione IRCCS Policlinico San Matteo, Italy.

"Technical solutions are available to enable remote physician-patient interactions, which can be helpful during the pandemic. Health authorities should be urged to equip hospitals with such systems. This is not only to support COVID-19 patients in quarantine at home, but also to care for and guide patients needing to be protected from a potentially harmful infection in the hospital setting," commented lead author Dr. Tobias Boettler, Department of Medicine II, Faculty of Medicine, University of Freiburg, Germany.

This Position Paper will also be published shortly in the open access journal, JHEP Reports.