Here, in this article Dr. Vikram Raut gives some advice for Liver care that should be followed during this COVID-19. Almost a year after the start of COVID-19 pandemic, it has become increasingly evident that pre-existing liver diseases and liver injury during the disease course must be kept in mind when caring for patients with COVID-19.
Fatty liver disease:
Obesity-associated with fatty liver represents a significant risk factor for a severe course of COVID-19 with severe pneumonia being particularly increased in men. It has been assumed that adipose tissue may serve both as a viral reservoir and also an immunological hub for the inflammatory response. Fatty liver is also associated with hypertension and diabetes is commonly observed in patients with severe COVID-19.
Depending on the nature of the chronic liver disease, the risk of infection or a serious course of COVID-19 can vary.
Due to cirrhosis-related immune dysfunction, patients with cirrhosis are at a higher risk of infections and associated complications, which is particularly significant for patients with decompensated cirrhosis.
Liver transplantation recipients:
The clinical course of COVID-19 in immunosuppressed transplant recipients is different. Indeed, the liver injury appears to be relatively less prevalent, kidney injury is more common in transplant recipients with COVID-19.
Recommendations for the liver care:
– During COVID- 19 Pandemic, it is essential to keep regular checks to monitor liver health and avoid frequent hospital visits for liver care.
I- In patients with liver disease, use telemedicine and local laboratory testing for follow-up visits.
– Stop the adverse metabolic and hepatic effects of social isolation, such as increased lifestyle and consumption of junk foods
– Preventing the progression of liver disease through intensive lifestyle interventions such as nutritional counselling, weight loss advice, and diabetes management may help to avoid the development of a serious disease path with potential SARS-CoV-2 infection.
– Treatment for arterial hypertension should be continued according to recommended guidelines.
– All patients with cirrhosis who become infected with SARS-CoV-2 should be admitted as soon as possible.
– To avoid decompensation and admission, follow the guidelines for prophylaxis of spontaneous bacterial peritonitis, gastrointestinal haemorrhage, and hepatic encephalopathy
– All patients with cirrhosis should receive vaccination for Streptococcus Pneumonia and influenza.
Liver transplant candidates
1. Following SARS-CoV-2 infection, patients waiting for liver transplantation with decompensated cirrhosis are at a high risk of serious COVID-19 infection and death.
2. Liver transplantation should be prioritized for patients with poor short-term prognosis including those with acute liver failure, acute decompasation and liver cancer.
3. Living donor transplants should be considered with careful risk stratification of donor and recipient, incorporating a combination of clinical history, chest radiology, and SARS-CoV-2 testing.
About Dr. Vikram Raut:
Dr. Vikram Raut is a senior consultant hepatobiliary and lead liver transplantation surgeon. He has extensive experience of Living-donor liver transplantation, with cumulative experience of over 1200 liver transplants, and performed more than 500 Living liver donor surgery.
He is trained in Liver Transplantation and HPB surgery with pioneers in liver transplants in Japan, France, and South Korea. Dr. Vikram was awarded with “International Travel Scholar Award 2010” from the International Liver transplantation society.
To make liver transplantation accessible, Dr. Vikram Raut’s team invented a public-private philanthropic model for financial assistance to children with liver disease. Funds for transplant were raised through the help of charitable trusts and crowdfunding.
Dr. Vikram Raut is an experienced liver transplant surgeon heading the most successful liver transplant program in western India. His expertise includes liver resection and transplantation for liver cancers, split liver transplantation, ABO-incompatible liver transplantation.