key: cord-1047875-5ch3ujko
authors: Ng, Alexander
title: Liver injury in liver transplant patients with COVID-19: a histopathological confirmation COVID-19 liver injury after transplantation
date: 2021-02-10
journal: Clin Gastroenterol Hepatol
DOI: 10.1016/j.cgh.2021.02.016
sha: 8fc4b3bfde88cca808b50748b8cfbb8edf1fb0f2
doc_id: 1047875
cord_uid: 5ch3ujko

nan

I welcome the results reported by Kaltschmidt and colleagues. 1 They undoubtedly carry significant implications towards liver transplant (LT) patients infected with COVID-19.

The study investigated patterns of liver injury and recovery in 60 patients who died of COVID-19 pneumonia between March and June 2020.

13 patients who died of non-COVID-19 fatal pneumonia served as the control. COVID-19 patients more frequently exhibited platelet microaggregates in the microvasculature of the liver (70% vs 30%; p=0.032). This is expected since severe COVID-19 entails a hyperinflammatory, hypercoagulable state with significantly higher rates of thromboembolism. 2 More COVID-19 patients also experienced sinusoidal dilation exceeding 75% (p=0.024). Portal dilation was also more frequently observed (p=0.002). SARS-CoV-2 was detected in 25% of all COVID-19 patient liver samples. Furthermore, more COVID-19 patients had higher-grade hepatic steatosis, with approximately 40% of cases at grade 2/3. The micro-vesicular variant was more preponderant in this cohort. As COVID-19 patients exhibited greater extent of liver damage, there were greater activation of intrahepatic stem cell niche, and more regenerative clusters of hepatocytes in intrahepatic bile ductules. This led to aberrant regeneration efforts.

Such results proffer us an alternative view of the long-term consequences of LT patients with COVID-19. These patients were found to experience more severe disease. A US multicentre observational study showed that 72.3% (n=81) patients were hospitalised, and 37.0% (n=30) were admitted to the ICU. 23.2% (n=26) were given mechanical ventilation. 3 Such results corroborated with those from a Spanish nationwide study.

86.5% (n=96) were hospitalised, 4 

Medicine (Baltimore)