Vaccination in liver diseases and liver Transplantation: Recommendations, implications and opportunities in the post-covid era.

The interest in vaccination efficacy and toxicity has surged following the Covid-19 pandemic. Immune responses to several vaccines have been shown to be suboptimal in patients with chronic liver disease (CLD) or post-liver transplant (LT), as a consequence of cirrhosis-associated immune dysfunction (CAID) or post-LT immunosuppression respectively. Accordingly, vaccine-preventable infections may be more common or severe than in the general population. The Covid-19 pandemic has greatly accelerated research and development into vaccination technology and platforms, which will have spillover benefits for liver patients. The aims of this review are: (i) to discuss the impact of vaccine-preventable infections on CLD and post-LT patients, (ii) to appraise current evidence supporting vaccination strategies, and (iii) to provide some insight into recent developments relevant for liver patients.

Impact of COVID-19 on the liver and on the care of patients with chronic liver disease, hepatobiliary cancer, and liver transplantation: An updated EASL position paper.

The COVID-19 pandemic has presented a serious challenge to the hepatology community, particularly healthcare professionals and patients. While the rapid development of safe and effective vaccines and treatments has improved the clinical landscape, the emergence of the omicron variant has presented new challenges. Thus, it is timely that the European Association for the Study of the Liver provides a summary of the latest data on the impact of COVID-19 on the liver and issues guidance on the care of patients with chronic liver disease, hepatobiliary cancer, and previous liver transplantation, as the world continues to deal with the consequences of the COVID-19 pandemic.

SARS-CoV-2 infection and liver involvement.

The COVID-19 pandemic is the largest public health challenge in living memory. Patients with underlying liver disease have been disproportionately affected, experiencing high morbidity and mortality. In addition, elevated liver enzymes appear to be a risk factor for disease progression, even in the absence of underlying liver disease. Nevertheless, the mechanism of liver injury in SARS-CoV-2 infection remains largely unknown. This review aims to provide an overview of the mechanisms by which SARS-CoV-2 induces liver injury, and the impact of COVID-19 on cirrhosis, alcohol-related liver disease, autoimmune liver disease, non-alcoholic fatty liver disease, hepatitis B and C virus infection, liver-transplant recipients and patients with hepatocellular carcinoma. Finally, emerging data on vaccination in liver diseases is discussed, to help inform public health policy.

CirrhoCare®-a pilot study of digital home management of advanced cirrhosis to determine feasibility and utility to diagnose new decompensation events

Background and AimsPatients discharged from hospital following acute decompensation are at high risk of new complications and need close follow-up, limited currently by the growing burden of cirrhosis and impact of COVID-19. Specialist liver care in the community is an unmet need, to reduce hospital exposure and manage new decompensation events.MethodsWe included 20 patients with cirrhosis and recent acute decompensation. Commercially available devices and a smartphone (+SIM card) were given to all patients for daily recording of ECG, blood pressure, weight, and% body-water (bioimpedance), Stroop test (hepatic encephalopathy (HE) assessment), and self-reported well-being and food/fluid/alcohol intake. Data was Blue-toothed via a secure server to the CirrhoCare®-App, which had 2-way patient-physician communication. Hepatologists evaluated daily data and facilitated interventions as required. A matched control cohort (n=20) with advanced cirrhosis was observed in parallel.ResultsPatient demographics: Mean age 59±10 years, 14 male, main etiology alcohol (75%);75% Child-Pugh class B. Fifteen patients (75%) showed good compliance, (≥4 readings/week), 2 had moderate compliance (2–4/week), and 3 had poor compliance (<2/week). In a usability questionnaire scored 1–10, the median score was ≥9 for any given question.Mean follow-up was 10.1±2.4 weeks. Amongst CirrhoCare® managed patients, 1 died and 1 received a liver transplant. Eight readmissions occurred in 5 different patients: 3 due to HE, 1 to acute-kidney injury (AKI), 1 to both AKI and HE, and 3 in the same patient to rectal bleeding. The median readmission lasted 5 (IQR 3.5–11) days, and none was >14 days. Except for the acute bleeds, we identified early signs of decompensation in all cases, e.g. failed Stroop test, hypotension or reduction/gain in body fluid (weight), and facilitated 2 short hospitalizations of the 8 total readmissions.Based on early signs of decompensation, we contacted patients on 16 other occasions, guiding intervention and likely preventing further readmissions as confirmed by an independent physician panel. Two controls died during follow-up, and there were 13 readmissions in 8 patients, lasting median 7 (IQR 3–15) days with four admissions >14 days. They had 6 unplanned paracenteses compared to 1 in CirrhoCare®-managed patients.ConclusionsCirrhoCare®’s novel, multimodal, home-monitoring in patients with advanced cirrhosis is feasible with excellent patient engagement, and prompts early diagnosis of decompensating events and their intervention;and hospital admissions are fewer and shorter in duration than in controls. We propose the application of CirrhoCare® for assisted, specialist, community management of advanced cirrhosis.

Impact of COVID-19 on the care of patients with liver disease: EASL-ESCMID position paper after 6 months of the pandemic.

During the early stages of the coronavirus disease 2019 (COVID-19) pandemic, EASL and ESCMID published a position paper to provide guidance for physicians involved in the care of patients with chronic liver disease. While some healthcare systems are returning to a more normal routine, many countries and healthcare systems have been, or still are, overwhelmed by the pandemic, which is significantly impacting on the care of these patients. In addition, many studies have been published focusing on how COVID-19 may affect the liver and how pre-existing liver diseases might influence the clinical course of COVID-19. While many aspects remain poorly understood, 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. This review should serve as an update on the previous position paper, summarising the evidence for liver disease involvement during COVID-19 and providing recommendations on how to return to routine care wherever possible.