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Management of patients with autoimmune liver disease during COVID-19 pandemic

  • Ana Lleo
    Correspondence
    Corresponding author. Address: Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Clinical and Research Center IRCCS, Via A. Manzoni 56, 20089 Rozzano (MI), Italy.
    Affiliations
    Division of Internal Medicine and Hepatology, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy

    Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy

    European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
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  • Pietro Invernizzi
    Affiliations
    European Reference Network on Hepatological Diseases (ERN RARE-LIVER)

    Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
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  • Ansgar W. Lohse
    Affiliations
    European Reference Network on Hepatological Diseases (ERN RARE-LIVER)

    Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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  • Alessio Aghemo
    Affiliations
    Division of Internal Medicine and Hepatology, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy

    Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy

    European Reference Network on Hepatological Diseases (ERN RARE-LIVER)
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  • Marco Carbone
    Affiliations
    European Reference Network on Hepatological Diseases (ERN RARE-LIVER)

    Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
    Search for articles by this author
Published:April 10, 2020DOI:https://doi.org/10.1016/j.jhep.2020.04.002
      Although coronavirus disease 2019 (COVID-19) is mainly characterised by respiratory symptoms that can progress to acute respiratory distress syndrome (ARDS),
      • Guan W.J.
      • Ni Z.Y.
      • Hu Y.
      • Liang W.H.
      • Ou C.Q.
      • He J.X.
      • et al.
      Clinical characteristics of coronavirus disease 2019 in China.
      ,
      • Huang C.
      • Wang Y.
      • Li X.
      • Ren L.
      • Zhao J.
      • Hu Y.
      • et al.
      Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.
      abnormalities in liver enzymes have been reported during severe infections.
      • Zhang C.
      • Shi L.
      • Wang F.S.
      Liver injury in COVID-19: management and challenges.
      Many liver centres worldwide have faced the challenge of managing patients with liver diseases during this pandemic
      • Zhang C.
      • Shi L.
      • Wang F.S.
      Liver injury in COVID-19: management and challenges.
      and particular concerns have been raised about immunocompromised patients. This is mainly based on previous data on the higher risk of severe respiratory viral infections in patients treated with immunosuppressive medications.
      • Kirchgesner J.
      • Lemaitre M.
      • Carrat F.
      • Zureik M.
      • Carbonnel F.
      • Dray-Spira R.
      Risk of serious and opportunistic infections associated with treatment of inflammatory bowel diseases.
      ,
      • Kaltsas A.
      • Sepkowitz K.
      Community acquired respiratory and gastrointestinal viral infections: challenges in the immunocompromised host.
      However, preliminary experience from Bergamo, Lombardy, suggests that immunosuppressed patients are not at increased risk during COVID-19;
      • D'Antiga L.
      Coronaviruses and immunosuppressed patients. The facts during the third epidemic.
      while Chinese data from the epicentre of the infection show that patients with chronic liver disease were only a minority among those infected with COVID-19.
      • Huang C.
      • Wang Y.
      • Li X.
      • Ren L.
      • Zhao J.
      • Hu Y.
      • et al.
      Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.
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