COVID-19: An Overview of Worldwide Recommendations for Management of Patients With Liver Diseases or Liver Transplantation

We read with great interest the recent article published in Clinical Gastroenterology and Hepatology by Donato et al1Donato M.F. et al.Clin Gastroenterol Hepatol. 2020 Apr 22; (S1542-3565(20)30538-3. doi: 10.1016/j.cgh.2020.04.041 [Epub ahead of print])Google Scholar reporting the results of a survey administered to a large sample of transplanted patients during the coronavirus 2019 disease (COVID-19) outbreak. The authors used telemedicine for providing measures to prevent the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to follow the development of COVID-19 symptoms in transplant recipients in Italy. We provide an overview of the recommendations provided by national and international gastroenterology/hepatology societies for the management of patients with chronic liver diseases or liver transplantation during the COVID-19 pandemic. We searched websites of 125 national and international societies of gastroenterology/hepatology from 7 international associations and 83 countries to extract data on the recommendations for management of patients with chronic liver disease, autoimmune hepatitis (AIH), hepatocellular carcinoma (HCC), or liver transplantation during the COVID-19 pandemic (Supplementary Methods). The final sample included recommendations for patients with chronic liver disease from 20 national or international societies, 7 specifically concerning patients with AIH, 7 for those with HCC, and 9 on liver transplantation (Supplementary Figure 1 and Supplementary Tables 1-3). Six societies stated that recommendations from other societies should be followed. Therefore, we analyzed the recommendations from 14 societies (Table 1). Briefly, all societies recommended the use of telemedicine (100%), and 12 societies (86%) recommended temporarily postponing nonurgent appointments. Questionnaire of symptoms (29%) and/or patient's body temperature measurement (29%), limiting the number of consultations per day, and restricting number of family and/or companions (57%) were recommended in case of face-to-face consultation. Few societies recommended checking influenza/Streptococcus pneumoniae vaccination (29%), delaying HCC surveillance (29%), and/or postponing all elective/nonurgent liver biopsy or elastography (29%). A majority of the societies recommended temporarily postponing all elective/nonurgent endoscopy examinations (86%) and to continue immunosuppressive therapy (93%). On the other hand, few societies recommended testing for SARS-CoV-2 in patients with hepatic decompensation.Table 1Recommendations for the Management of Patients With Chronic Liver Disease During the COVID-19 Pandemic From International/National Societies of Gastroenterology or Hepatology Updated on April 10, 2020Society nameDateScreening of symptomsCheck patients' body temperaturePostpone elective consultationLimit number of patients/family in consultationUse of telemedicinePrescription for next monthVaccination for influenza/S pneumoniaeContinue immunosuppressive therapyDelay HCC/ varices screeningPostpone elective GIEPostpone elective liver biopsy/TEInternational European Association for the Study of the LiverApril 2, 2020NRNRYesNRYesYesYesYesYesYesYesUnited States/Canada American College of GastroenterologyMarch 15, 2020YesYesYesYesYesNRNRYesNRYesNR American Gastroenterological AssociationMarch 15, 2020YesYesYesYesYesNRNRYesNRYesNR American Association for the Study of Liver DiseasesApril 7, 2020YesYesYesYesYesYesNRYesYesYesYesEurope Association Française Pour l'Etude du FoieApril 6, 2020YesYesYesNRYesYesYesYesYesYesYes Swiss Association for the Study of the LiverApril 3, 2020NRNRYesNRYesNRNRYesNRYesYes British Society of GastroenterologyMarch 14, 2020NRNRYesNRYesNRNRYesNRYesNR The British Association for the Study of the LiverMarch 18, 2020NRNRYesYesYesNRNRYesNRNRNRLatin America Asociación Argentina para el Estudio de las Enfermedades de HígadoNANRNRYesYesYesYesYesYesYesYesNR Sociedade Brasileira de HepatologiaMarch 22, 2020NRNRYesNRYesYesNRYesNRYesNR Asociación Chilena de HepatologíaNANRNRNRNRYesNRNRNRNRYesNRAsia-Pacific Gastroenterological Society of AustraliaMarch 19, 2020NRNRNRYesYesNRYesYesNRNRNR Pakistan Society for the Study of Liver DiseasesNANRNRYesYesYesNRNRYesNRYesNRAfrica Société Algérienne d'Hépato-Gastro-entérologie et d'Endoscopie DigestiveMarch 15, 2020NRNRYesYesYesYesNRYesNRYesNRNOTE. The Société Algérienne d'Hépato-Gastro-entérologie et d'Endoscopie Digestive is affiliated with the European Association for the Study of the Liver. The American College of Gastroenterology and the American Gastroenterological Association recommendations were based on a joint document from the American Gastroenterological Association, American College of Gastroenterology, American Association for the Study of Liver Diseases, and American Society of Gastrointestinal Endoscopy. Other recommendations were as follows: continuation of current hepatitis B virus/hepatitis C virus treatment (American Association for the Study of Liver Diseases, European Association for the Study of the Liver, and Gastroenterological Society of Australia), consider delaying new HCV treatments (American Association for the Study of Liver Diseases and Association Française Pour l'Etude du Foie) and test severe acute respiratory syndrome coronavirus 2 in patients with hepatic decompensation (European Association for the Study of the Liver). Urgent procedures that could not be stopped during the coronavirus 2019 pandemic were as follows: liver biopsy to rule out rejection or to diagnose autoimmune hepatitis (American Association for the Study of Liver Diseases, Association Française Pour l'Etude du Foie, and Sociedade Brasileira de Hepatologia), therapeutic paracentesis (American Association for the Study of Liver Diseases and Association Française Pour l'Etude du Foie), transjugular intrahepatic portosystemic shunt (American Association for the Study of Liver Diseases, Sociedade Brasileira de Hepatologia), and upper gastrointestinal endoscopy for variceal bleeding and endoscopic band-ligation (American Association for the Study of Liver Diseases, Association Française Pour l'Etude du Foie, and Sociedade Brasileira de Hepatologia). A total of 6 societies advised following current recommendations for coronavirus 2019 from other societies: United European Gastroenterology (American Association for the Study of Liver Diseases/European Association for the Study of the Liver); World Gastroenterology Organisation (American Association for the Study of Liver Diseases/European Association for the Study of the Liver); Belgian Association for the Study of the Liver (European Association for the Study of the Liver); Société Royale Belge de Gastro-Entérologie (European Association for the Study of the Liver); Indian National Association for Study of the Liver (American Association for the Study of Liver Diseases), and New Zealand Society of Gastroenterology (not reported).GIE, gastrointestinal endoscopy; NA, not available; NR, not reported; TE, transient elastography. Open table in a new tab NOTE. The Société Algérienne d'Hépato-Gastro-entérologie et d'Endoscopie Digestive is affiliated with the European Association for the Study of the Liver. The American College of Gastroenterology and the American Gastroenterological Association recommendations were based on a joint document from the American Gastroenterological Association, American College of Gastroenterology, American Association for the Study of Liver Diseases, and American Society of Gastrointestinal Endoscopy. Other recommendations were as follows: continuation of current hepatitis B virus/hepatitis C virus treatment (American Association for the Study of Liver Diseases, European Association for the Study of the Liver, and Gastroenterological Society of Australia), consider delaying new HCV treatments (American Association for the Study of Liver Diseases and Association Française Pour l'Etude du Foie) and test severe acute respiratory syndrome coronavirus 2 in patients with hepatic decompensation (European Association for the Study of the Liver). Urgent procedures that could not be stopped during the coronavirus 2019 pandemic were as follows: liver biopsy to rule out rejection or to diagnose autoimmune hepatitis (American Association for the Study of Liver Diseases, Association Française Pour l'Etude du Foie, and Sociedade Brasileira de Hepatologia), therapeutic paracentesis (American Association for the Study of Liver Diseases and Association Française Pour l'Etude du Foie), transjugular intrahepatic portosystemic shunt (American Association for the Study of Liver Diseases, Sociedade Brasileira de Hepatologia), and upper gastrointestinal endoscopy for variceal bleeding and endoscopic band-ligation (American Association for the Study of Liver Diseases, Association Française Pour l'Etude du Foie, and Sociedade Brasileira de Hepatologia). A total of 6 societies advised following current recommendations for coronavirus 2019 from other societies: United European Gastroenterology (American Association for the Study of Liver Diseases/European Association for the Study of the Liver); World Gastroenterology Organisation (American Association for the Study of Liver Diseases/European Association for the Study of the Liver); Belgian Association for the Study of the Liver (European Association for the Study of the Liver); Société Royale Belge de Gastro-Entérologie (European Association for the Study of the Liver); Indian National Association for Study of the Liver (American Association for the Study of Liver Diseases), and New Zealand Society of Gastroenterology (not reported). GIE, gastrointestinal endoscopy; NA, not available; NR, not reported; TE, transient elastography. Concerning patients with AIH, HCC, or liver transplantation, telemedicine was recommended extensively for patients with AIH or liver transplantation (86%), but in lower rates for patients with HCC (57%) (Supplementary Table 1). The maintenance of the same dosage of immunosuppressive agents was highly recommended for patients with AIH (86%) or liver transplantation (100%). The majority of societies (67%) recommended performing SARS-CoV-2 testing for liver transplantation recipients and donors. All 7 societies with recommendations for patients with HCC recommended continuation of HCC therapy, and 4 (57%) of them recommended continuing to perform regular examinations during the pandemic. Most societies recommended performing liver transplantation only for life-threatening situations, such as HCC or acute liver failure. The impact of COVID-19 in patients with liver diseases or liver transplantation remains unclear. Preliminary results of combined data from registries that have been collecting outcomes of suspected/confirmed COVID-19 in patients with liver diseases showed high mortality rates in patients with cirrhosis.2Combined data of SECURE-Cirrhosis and COVID-HEP, 2020.https://covidcirrhosis.web.unc.edu/updates-and-dataDate accessed: April 23, 2020Google Scholar However, there are no published results yet of prospective studies that followed up patients with chronic liver disease/liver transplantation and COVID-19. Telemedicine is low cost, widely available, and well accepted by patients and clinicians.3Serper M. et al.Hepatology. 2020 Apr 10; (10.1002/hep.31276. doi: 10.1002/hep.31276 [Epub ahead of print])Google Scholar However, this technology might be challenged by differences in local regulations for telehealth services and/or reimbursement in each country/region.4Marcoux R.M. et al.Pharm Ther. 2016; 41: 567-570Google Scholar The risk of a flare of AIH or acute cellular rejection after liver transplantation secondary to unnecessary immunosuppressive reduction/withdrawal would overcome the risk of SARS-CoV-2 infection.5Lleo A. et al.J Hepatol. 2020 Apr 10; (S0168-8278(20)30212-9. doi: 10.1016/j.jhep.2020.04.002. [Epub ahead of print])PubMed Google Scholar High rates of hospital admission in critical care units have been leading to a shortage of health care workers, beds, ventilators, and blood products for HCC therapies and liver transplantation during the COVID-19 pandemic. Thus, health authorities should consider deviations from the current standard of care until definitive therapy can be delivered.6Meyer T. et al.ILCA guidance for management of HCC during COVID-19 pandemic. International Liver Cancer Association 2020.https://mcusercontent.com/ab4445175c75a57073d4ad02d/files/04c3c6de-7f63-4bb6-86a3-6c3e56242728/ILCA_COVID_19_.pdfDate accessed: April 20, 2020Google Scholar It is worth noting that we relied on current available recommendations from international and national societies of gastroenterology/hepatology when writing this article. However, the results of our worldwide overview are aligned with the clinical recommendations and policies to mitigate the impact of the COVID-19 pandemic on patients with chronic liver diseases recently published by expert consensus.7Boettler T. et al.J Hepatol Rep. 2020; 2: 100113Scopus (364) Google Scholar,8Fix O.K. et al.Hepatology. 2020 Apr 16; (10.1002/hep.31281. doi: 10.1002/hep.31281. [Epub ahead of print])PubMed Google Scholar Large-scale testing might benefit patients at high risk of complications. Furthermore, while we wait for effective vaccines, the knowledge of the extent of immunity in each country will later guide health authorities to elaborate strategies when facing a potential second wave of COVID-19. Patients with cirrhosis and those on immunosuppressive medicines should be prioritized for testing until further evidence-based data become available. In summary, worldwide gastroenterology and hepatology societies support the use of telehealth for managing patients with liver disease or liver transplantation. Hepatology and liver transplantation providers should follow the current recommendations to protect their patients during the COVID-19 pandemic. However, future studies addressing the impact of COVID-19 in patients with chronic liver diseases or liver transplantation are needed urgently. To identify the recommendations for care of patients with chronic liver diseases during the COVID-19 pandemic, we performed searches on the websites of the US and international societies of gastroenterology and hepatology (American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Liver Foundation, Asian Pacific Association for the Study of the Liver, Asian Pacific Association of Gastroenterology, Asociación Latinoamericana para el Estudio del Higado, European Association for the Study of the Liver, United European Gastroenterology, World Gastroenterology Organisation, and World Hepatitis Alliance) and their affiliated national associations on April 10, 2020. Gastroenterology and hepatology societies/associations without an available website in English, French, Spanish, or Portuguese, and those without a specific report/statement document for managing patients with chronic liver diseases during the COVID-19 pandemic, were excluded. The following data were extracted from documents uploaded by each society: date of the recommendation, suggestions to temporarily postpone elective consultations and nonurgent procedures, to use telemedicine/telehealth for consultations, to limit patients/family members in clinics and to screen signs/symptoms in those individuals attending face-to-face consultations, to prescribe medical prescriptions for the next months, to check vaccination records, and recommendations on the use of immunosuppressive agents during the COVID-19 pandemic. Moreover, we collected specific recommendations for patients with AIH, HCC, and recipients of liver transplantation when available.Supplementary Table 1Recommendations for the Management of Patients With Autoimmune Hepatitis or Hepatocellular Carcinoma and for Liver Transplantation During the COVID-19 Pandemic From International/National Societies of Gastroenterology or Hepatology Updated on April 10, 2020SocietyRegionContinue immunosuppressive therapyUse of telemedicinePrescription for next monthVaccination for influenza/S pneumoniaeAutoimmune hepatitis European Association for the Study of the LiverInternationalYesYesYesYes American Association for the Study of Liver DiseasesUnited States/CanadaYesYesYesNR Belgian Association for the Study of the LiverEuropeNRNRNRNR Association Française Pour l'Etude du FoieEuropeYesYesYesYes Swiss Association for the Study of the LiverEuropeYesYesNRNR The British Association for the Study of the LiverEuropeYesYesNRNR New Zealand Society of GastroenterologyAsia-PacificYesYesNRNRContinue HCC therapyContinue examinations and evaluationsHepatocellular carcinoma European Association for the Study of the LiverInternationalYesYesYesNR American Association for the Study of Liver DiseasesUnited States/CanadaYesYesYesNR Association Française Pour l'Etude du FoieEuropeYesNRNRNR Swiss Association for the Study of the LiverEuropeYesNRNRNR Asociación Argentina para el Estudio de las Enfermedades de HígadoLatin AmericaYesNRNRNR Sociedade Brasileira de HepatologiaLatin AmericaYesYesYesNR New Zealand Society of GastroenterologyAsia-PacificYesYesYesNRContinue immunosuppressive therapyTest SARS-CoV-2 for recipients and donorsLiver transplantation European Association for the Study of the LiverInternationalYesYesYesYes American Association for the Study of Liver DiseasesUnited States/CanadaYesYesYesNR Belgian Association for the Study of the LiverEuropeYesNRYesNR Swiss Association for the Study of the LiverEuropeYesYesNRYes British Society of GastroenterologyEuropeYesYesNRNR The British Association for the Study of the LiverEuropeYesYesYesNR Sociedade Brasileira de HepatologiaLatin AmericaYesYesYesNR Indian National Association for Study of the LiverAsia-PacificYesYesYesNR New Zealand Society of GastroenterologyAsia-PacificYesYesNRNRNOTE. The Belgian Association for the Study of the Liver (Belgium) and the Sociedade Brasileira de Hepatologia (Brazil) recommended continuing performing liver transplantation for all patients; the European Association for the Study of the Liver/American Association for the Study of Liver Diseases (International), British Society of Gastroenterology/British Association for the Study of the Liver (United Kingdom), and the New Zealand Society of Gastroenterology (New Zealand) recommended performing liver transplantation only for life-threatening situations, such as HCC and acute liver failure.HCC, hepatocellular carcinoma; NR, not reported; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. Open table in a new tab Supplementary Table 2Gastroenterology/Hepatology Societies Accessed to Review the Recommendations for Management of Patients With Chronic Liver Diseases or Transplantation During the COVID-19 Pandemic: Updated on April 10, 2020CountrySociety nameMemberURLInternationalAsociacion Latinoamericana para el Estudio del HigadoNot applicablehttps://alehlatam.org/InternationalAsian Pacific Association for the Study of the LiverNot applicablehttp://apasl.info/InternationalAsian Pacific Association of GastroenterologyNot applicablehttp://www.apage.org/index.htmlInternationalEuropean Association for the Study of the LiverNot applicablehttps://easl.eu/InternationalUnited European GastroenterologyNot applicablehttps://www.ueg.eu/home/InternationalWorld Gastroenterology OrganisationNot applicablehttp://www.worldgastroenterology.org/InternationalWorld Hepatitis AllianceNot applicablehttps://www.worldhepatitisalliance.org/United StatesAmerican College of GastroenterologyNot applicablehttps://gi.org/United StatesAmerican Gastroenterological AssociationNot applicablehttps://www.gastro.org/United StatesAmerican Association for the Study of Liver DiseasesNot applicablehttps://www.aasld.org/United StatesAmerican Liver FoundationNot applicablehttps://liverfoundation.org/Europe AlbaniaShoqata Shqiptare Gastro-Entero-HepatologjisëUEGNot available ArmeniaArmenian Gastroenterology AssociationUEGNot available ArmeniaArmenian Hepatological ForumEASLNot available AustriaÖsterreichische Gesellschaft für Gastroenterologie und HepatologieUEG/EASLhttp://www.oeggh.at/ AzerbaijanAzerbaijan Gastroenterologists and Hepatologists SocietyUEG/EASLhttp://qastro-hep.az/ BelarusByelorussian Gastroenterology AssociationEASL BelgiumSociété Royale Belge de Gastro-EntérologieUEGhttp://www.srbge.be BelgiumVlaamse Vereniging voor GastroenterologieUEGhttp://www.vvge.be BelgiumBelgian Association for the Study of the LiverEASLwww.basl.be Bosnia and HercegovinaAssociation of Gastroenterohepatologists in Bosnia and HercegovinaUEG/EASLhttp://www.geha.ba BulgariaBulgarian Society of GastroenterologyUEG/EASLhttp://www.bsg.bg CroatiaHrvatsko gastroenterološko društvoUEG/EASLhttp://www.hgd.hr Czech RepublicCzech Society of GastroenterologyUEGhttp://www.cgs-cls.cz Czech RepublicCzech Society of HepatologyEASLwww.ces-hep.cz DenmarkDanish Gastroenterology and Hepatology AssociationUEG/EASLhttp://www.dsgh.dk EstoniaEesti Gastroenteroloogide Selts, Estonian Society of GastroenterologyUEG/EASLNot available FinlandSuomen Gastroenterologiayhdistys ryUEG/EASLhttp://www.gastroenterologiayhdistys.fi FranceSociété Nationale Française de Gastro-EntérologieUEGhttps://www.snfge.org FranceAssociation Française Pour l'Etude du FoieEASLwww.afef.asso.fr GeorgiaGeorgian National Gastroenterology And Hepatology SocietyUEG/EASLNot available GermanyDeutsche Gesellschaft für Gastroenterologie, Verdauungs- und StoffwechselkrankheitenUEGhttp://www.dgvs.de GermanyGerman Society for the Study of the LiverEASLwww.gasl.de GreeceHellenic Society of GastroenterologyUEGhttp://www.hsg.gr GreeceHellenic Association for the Study of the LiverEASLwww.eemh.gr HungaryMagyar Gasztroenterológiai TársaságUEGhttp://www.gastroent.hu HungaryHungarian Liver Research SocietyEASLNot available IrelandIrish Society of GastroenterologyUEG/EASLhttp://www.isge.ie IsraelIsrael Gastroenterological AssociationUEGhttp://gastro.doctorsonly.co.il/ IsraelIsrael Association for the Study of Liver DiseasesEASLNot available ItalyAssociazione Italiana Gastroenterologi ed Endoscopisti Digestivi OspedalieriUEGhttp://www.webaigo.it/ ItalySocietà Italiana di Gastroenterologia ed Endoscopia DigestivaUEGhttp://www.sigeitalia.it ItalyItalian Association for the Study of the Liver Associazione Italiana per lo Studio del FegatoEASLwww.webaisf.org KazakhstanGastroHepatoTransplantGroup AstanaEASLNot available KosovoShoqata e Gastroenterologëve të KosovësUEGhttps://www.shgk-rks.org/ LatviaGastroenterologijas Atbalsta BiedribaUEGhttp://www.gastroenterologs.lv LatviaLatvian Association of Infectologists and HepatologistsEASLNot available LithuaniaLietuvos Gastroenterology DraugijaUEG/EASLhttp://www.gastroenterologija.lt/ LuxembourgSociété Luxembourgeoise de Gastro-EntérologieUEGNot available MediterraneanMediterranean Association for the Study of the LiverEASLNot available MontenegroGastroenterohepatology Association of MontenegroUEGhttp://www.ugcg.me North MacedoniaNorth Macedonian Society of GastroenterohepatologyUEGNot available NorwayNorsk Gastroenterologisk ForeningUEG/EASLhttps://www.legeforeningen.no/ PolandPolskie Towarzystwo GastroenterologiiUEGhttp://www.ptg-e.org.pl PolandPolish Association for the Study of the LiverEASLwww.pasl.pl PortugalSociedade Portuguesa de GastrenterologiaUEGhttp://www.spg.pt PortugalAssociação Portuguesa para o Estudo do FígadoEASLNot available RomaniaSocietatea Română de Gastroenterologie şi HepatologieUEGhttp://www.srgh.ro RomaniaRomanian Association for Liver DiseasesEASLwww.roald.ro RussiaRussian Gastroenterological AssociationUEGNot available Russian FederationRussian Scientific Liver SocietyEASLwww.rsls.ru SerbiaSerbian Gastroenterology AssociationUEGhttp://www.ugs.rs SerbiaHepatology section of the Serbian Medical SocietyEASLhttp://hepatoloska.sld.org.rs SlovakiaSlovenská Gastroenterologická SpoločnostUEGhttp://www.sgssls.sk SlovakiaSlovak Society of HepatologyEASLwww.hepatology.sk SloveniaSlovenian Society of GastroenterologyUEG/EASLhttp://www.szgh.si SpainAsociación Española de GastroenterologíaUEGhttp://www.aegastro.es/ SpainSociedad Española de Patología DigestivaUEGhttp://www.sepd.es SpainAsociacion Espanola para el Estudio del HigadoEASLwww.aeeh.es SwedenSvensk Gastroenterologisk FöreningUEG/EASLhttp://www.svenskgastroenterologi.se/ SwitzerlandSchweizerische Gesellschaft für GastroenterologieUEGhttp://www.sggssg.ch SwitzerlandSwiss Association for the Study of the LiverEASLwww.sasl.ch The NetherlandsNederlandse Vereniging voor Gastro-EnterologieUEGhttp://www.nvge.nl The NetherlandsNederlandse Vereniging van Maag-Darm-LeverartsenUEGhttp://www.mdl.nl The NetherlandsHepatologie Dutch Society for HepatologyEASLwww.nvh.nl TunisiaSociété Tunisienne de Gastro-EntérologieUEGhttp://www.stge.org.tn TurkeyTürk Gastroenteroloji DernegiUEGhttp://www.tgd.org.tr TurkeyTurkish Association for the Study of the LiverEASLhttp://tasl.org.tr UkraineUkrainian Gastroenterological AssociationUEGhttp://ukrgastro.com.ua/ UkraineUkrainian Association for the Study of the Liver DiseaseEASLNot available United KingdomBritish Society of GastroenterologyUEGhttps://www.bsg.org.uk/ United KingdomThe British Association for the Study of the LiverEASLwww.basl.org.ukCentral and Latin America ArgentinaAsociación Argentina para el Estudio de las Enfermedades de HígadoALEHwww.aaeeh.org.ar BrazilSociedad Brasileira de HepatologiaALEHwww.sbhepatologia.org.br BoliviaSociedad Boliviana de Gastroenterología y Endoscopia DigestivaALEHwww.gastrobolivia.org ChileAsociación Chilena de HepatologíaALEHwww.sociedadgastro.cl ColombiaAsociación Colombiana de HepatologíaALEHwww.higadocolombia.org Costa RicaAsociación Costarricense de Especialistas en Gastroenterología y EndoscopíaALEHwww.gastroenterologoscr.com CubaSociedad Cubana de GastroenterologíaALEHNot available EcuadorSociedad de Gastroenterología de EcuadorALEHhttp://www.gastroquito.med.ec GuatemalaAsociación Guatemalteca de Gastroenterología, Hepatología y Endoscopía GastrointestinalALEHwww.gastroenterologosdeguatemala.org HondurasAsociación Hondureña de GastroenterologíaALEHwww.asociaciondegastroenterologiadehonduras.org MexicoAsociación Mexicana de HepatologíaALEHwww.hepatologia.org.mx ParaguaySociedad Paraguaya de Gastroenterología y Endoscopia DigestivaALEHwww.spge.org.py PanamaAsociación Panameña de Gastroenterología y Endoscopía DigestivaALEHhttps://gastropanama.org/ PeruAsociación Peruana de HepatologíaALEHhttp://apeh.com.pe Puerto RicoAsociación Puertorriqueña de GastroenterologíaALEHwww.prgastro.org Republica DominicanaSociedad Dominicana de GastroenterologíaALEHwww.sodogastro.com UruguaySociedad de Gastroenterología del UruguayALEHwww.sgu.org.uy VenezuelaSección Hepatología de Sociedad Venezolana de GastroenterologíaALEHwww.sovegastro.orgCanada CanadaCanadian Association of GastroenterologyUnited States/Canadahttps://www.cag-acg.org/ CanadaCanadian Association for the Study of the LiverUnited States/Canadahttps://hepatology.ca/about-casl/Asia-Pacific region AustraliaAustralasian Hepatology AssociationAPASLhttp://www.hepatologyassociation.com.au/ AustraliaGastroenterological Society of AustraliaAPASLhttp://www.gesa.org.au/ ChinaChinese Society of GastroenterologyAPASLhttp://www.csge.org/ SingaporeGastroenterological Society of SingaporeAPASLhttp://www.gastro.org.sg/ ThailandThe Gastroenterological Association of ThailandAPASLhttp://www.gastrothai.net/eng/index.php ThailandThai Association for the Study of the LiverAPASLhttps://thasl.org/en/homepage/ PhilippinesHepatology Society of the PhilippinesAPASLhttps://hsp.org.ph/ Hong KongThe Hong Kong Society of GastroenterologyAPASLhttp://www.hksge.org/home.htm IndiaIndian National Association for Study of the LiverAPASLhttp://www.inasl.org.in/ IndonesiaIndonesian Association for the Study of the LiverAPASLhttp://pphi-online.org/alpha/ South KoreaKorean Society of GastroenterologyAPASLhttp://www.gastrokorea.org/eng/about/about.html MalaysiaMalaysian Liver FoundationAPASLhttp://www.liver.org.my/welcome.php MalaysiaMalaysian Society of Gastroenterology and HepatologyAPASLhttp://www.msgh.org.my/ NepalNepalese Association for the Studies of the LiverAPASLhttp://naslnepal.com/ New ZealandNew Zealand Society of Gastroenterology Inc.APASLhttp://www.nzsg.org.nz/ PakistanPakistan Society for the Study of Liver DiseasesAPASLhttp://pssld.org.pk/ PakistanPakistan Society of Gastroenterology and GI EndoscopyAPASLhttp://www.psg.org.pk/ Sri LankaSri Lanka Society of GastroenterologyAPASLhttp://slsg.lk/eng/index.php/en/ South AsiaSouth Asian Association for the Study of the LiverAPASLhttp://saasl.org/Africa AlgeriaSociété Algérienne d'Hépato-gastro-entérologie et d'Endoscopie digestiveUEGhttp://www.sahgeed.com EgyptEgyptian Association for Research and Training in HepatogastroenterologyUEGNot available EgyptEgyptian Association for the Study of Gastrointestinal and Liver DiseaseAPASLhttp://www.easgld.org/index.htm MoroccoSociété Marocaine des Maladies de l'Appareil DigestifUEGhttp://www.smmad-ma.comALEH, Asociacion Latinoamericana para el Estudio del Higado; APASL, Asian Pacific Association for the Study of the Liver; EASL, European Association for the Study of the Liver; UEG, United European Gastroenterology. Open table in a new tab Supplementary Table 3Web Links of Recommendations for Management of Patients With Chronic Liver Diseases or Liver Transplantation During the COVID-19 Pandemic From International/National Societies of Gastroenterology/Hepatology Updated on April 10, 2020CountrySociety nameWeb-site in English, French, Spanish, or PortugueseDate of recommendationURL of recommendation for management of patients with chronic liver diseases during COVID-19 pandemicInternationalAsociacion Latinoamericana para el Estudio del HigadoYesNot availableInternationalAsian Pacific Association for the Study of the LiverYesNot availableInternationalAsian Pacific Association of GastroenterologyYesNot availableInternationalEuropean Association for the Study of the LiverYesApril 2, 2020https://easl.eu/news/easl-escmid-position-paper-on-covid19-and-the-liver/InternationalUnited European GastroenterologyYesNot reportedhttps://www.ueg.eu/news/news/news-details/article/covid-19-scientific-information-for-the-digestive-health-community/InternationalWorld Gastroenterology OrganisationYesNot reportedhttps://www.worldgastroenterology.org/about-wgo/media-center/covid-19---a-message-from-wgo-president?utm_source=WGOBanner&utm_medium=Homepage&utm_campaign=WGOBanner_Homepage_COVID19#Patients%20Liver%20DiseaseInternationalWorld Hepatitis AllianceYesNot availableUnited StatesAmerican College of GastroenterologyYesMarch 15, 2020https://gi.org/media/covid-19-and-gi/United StatesAmerican Gastroenterological AssociationYesMarch 15, 2020https://www.gastro.org/press-release/joint-gi-society-message-covid-19-clinical-insights-for-our-community-of-gastroenterologists-and-gastroenterology-care-providersUnited StatesAmerican Association for the Study of Liver DiseasesYesApril 7, 2020https://www.aasld.org/about-aasld/covid-19-resourcesUnited StatesAmerican Liver FoundationYesNot availableEurope AlbaniaShoqata Shqiptare Gastro-Entero-HepatologjisëNoNot available ArmeniaArmenian Gastroenterology AssociationNoNot available ArmeniaArmenian Hepatological ForumNoNot available AustriaÖsterreichische Gesellschaft für Gastroenterologie und HepatologieNoNot available AzerbaijanAzerbaijan Gastroenterologists and Hepatologists SocietyYesNot available BelarusByelorussian Gastroenterology AssociationNoNot available BelgiumSociété Royale Belge de Gastro-EntérologieYesMarch 18, 2020https://www.srbge.be/wp-content/uploads/2020/03/200322_SRBGE_procedure_ambu_prive.pdf BelgiumVlaamse Vereniging voor GastroenterologieNoNot available BelgiumBelgian Association for the Study of the LiverYesNot reportedhttps://www.basl.be/news/covid-19-and-liver/ Bosnia and HercegovinaAssociation of Gastroenterohepatologists in Bosnia and HercegovinaNoNot available BulgariaBulgarian Society of GastroenterologyNoNot available CroatiaHrvatsko gastroenterološko društvoNoNot available Czech RepublicCzech Society of GastroenterologyYesNot available Czech RepublicCzech Society of HepatologyNoNot available DenmarkDanish Gastroenterology and Hepatology AssociationNoNot available EstoniaEesti Gastroenteroloogide Selts, Estonian Society of GastroenterologyNoNot available FinlandSuomen Gastroenterologiayhdistys ryNoNot available FranceSociété Nationale Française de Gastro-EntérologieYesNot available FranceAssociation Française Pour l'Etude du FoieYesApril 6, 2020https://afef.asso.fr/article_actu/covid-19-foie-retrouvez-lensemble-des-informations/ GeorgiaGeorgian National Gastroenterology And Hepatology SocietyNoNot available GermanyDeutsche Gesellschaft für Gastroenterologie, Verdauungs- und StoffwechselkrankheitenNoNot available GermanyGerman Society for the Study of the LiverNoNot available GreeceHellenic Society of GastroenterologyNoNot available GreeceHellenic Association for the Study of the LiverNoNot available HungaryMagyar Gasztroenterológiai TársaságYesNot available HungaryHungarian Liver Research SocietyNoNot available IrelandIrish Society of GastroenterologyYesNot available IsraelIsrael Gastroenterological AssociationNoNot available IsraelIsrael Association for the Study of Liver DiseasesNoNot available ItalyAssociazione Italiana Gastroenterologi ed Endoscopisti Digestivi OspedalieriNoNot available ItalySocietà Italiana di Gastroenterologia ed Endoscopia DigestivaNoNot available Italytalian Association for the Study of the Liver Associazione Italiana per lo Studio del FegatoYesNot available KazakhstanGastroHepatoTransplantGroup AstanaNoNot available KosovoShoqata e Gastroenterologëve të KosovësNoNot available LatviaGastroenterologijas Atbalsta BiedribaYesNot available LatviaLatvian Association of Infectologists and HepatologistsNoNot available LithuaniaLietuvos Gastroenterology DraugijaNoNot available LuxembourgSociété Luxembourgeoise de Gastro-EntérologieNoNot available MediterraneanMediterranean Association for the Study of the LiverNoNot available MontenegroGastroenterohepatology Association of MontenegroYesNot available North MacedoniaNorth Macedonian Society of GastroenterohepatologyNoNot available NorwayNorsk Gastroenterologisk ForeningNoNot available PolandPolskie Towarzystwo GastroenterologiiYesNot available PolandPolish Association for the Study of the LiverNoNot available PortugalSociedade Portuguesa de GastrenterologiaYesNot available PortugalAssociação Portuguesa para o Estudo do FígadoNoNot available RomaniaSocietatea Română de Gastroenterologie şi HepatologieNoNot available RomaniaRomanian Association for Liver DiseasesYesNot available Russian FederationRussian Gastroenterological AssociationNoNot available RussiaRussian Scientific Liver SocietyNoNot available SerbiaSerbian Gastroenterology AssociationNoNot available SerbiaHepatology section of the Serbian Medical SocietyNoNot available SlovakiaSlovenská Gastroenterologická SpoločnostNoNot available SlovakiaSlovak Society of HepatologyNoNot available SloveniaSlovenian Society of GastroenterologyNoNot available SpainAsociación Española de GastroenterologíaYesNot available SpainSociedad Española de Patología DigestivaYesNot available SpainAsociacion Espanola para el Estudio del HigadoYesNot available SwedenSvensk Gastroenterologisk FöreningNoNot available SwitzerlandSchweizerische Gesellschaft für GastroenterologieYesNot available SwitzerlandSwiss Association for the Study of the LiverYesApril 3, 2020https://sasl.unibas.ch/guidelines/SASL-Swiss%20hepatitis-SARS-CoV-2%20Recommendations%20French.pdf The NetherlandsNederlandse Vereniging voor Gastro-EnterologieNoNot available The NetherlandsNederlandse Vereniging van Maag-Darm-LeverartsenNoNot available The NetherlandsHepatologie Dutch Society for HepatologyNoNot available TunisiaSociété Tunisienne de Gastro-EntérologieYesNot available TurkeyTürk Gastroenteroloji DernegiNoNot available TurkeyTurkish Association for the Study of the LiverYesNot available UkraineUkrainian Gastroenterological AssociationNoNot available UkraineUkrainian Association for the Study of the Liver DiseaseNoNot available United KingdomBritish Society of GastroenterologyYesMarch 14, 2020https://www.bsg.org.uk/covid-19-advice/bsg-and-basl-covid-19-advice-for-healthcare-professionals-in-gastroenterology-and-hepatology/ United KingdomThe British Association for the Study of the LiverYesMarch 18, 2020https://www.basl.org.uk/index.cfm/news/list/cid/8Central and Latin America ArgentinaAsociación Argentina para el Estudio de las Enfermedades de HígadoYesNot reportedhttp://www.aaeeh.org.ar/index.php/profesionales/recomendaciones-covid19 BrazilSociedad Brasileira de HepatologiaYesMarch 22, 2020http://sbhepatologia.org.br/noticias/sbh-emite-nota-tecnica-sobre-covid-19/ BoliviaSociedad Boliviana de Gastroenterología y Endoscopia DigestivaNoNot available ChileAsociación Chilena de HepatologíaYesNot reportedhttp://www.sociedadgastro.cl/gastroweb/index.php/noticias/426-comunicado-conjunto-schge-asociaciones-agrupaciones-y-filiales-covid-19-mensaje-a-socios-sociedad-chilena-de-gastroenterologia-schge ColombiaAsociación Colombiana de HepatologíaYesNot available Costa RicaAsociación Costarricense de Especialistas en Gastroenterología y EndoscopíaYesNot available CubaSociedad Cubana de GastroenterologíaNoNot available EcuadorSociedad de Gastroenterología de EcuadorYesNot available GuatemalaAsociación Guatemalteca de Gastroenterología, Hepatología y Endoscopía GastrointestinalYesNot available HondurasAsociación Hondureña de GastroenterologíaYesNot available MexicoAsociación Mexicana de HepatologíaYesNot available ParaguaySociedad Paraguaya de Gastroenterología y Endoscopia DigestivaYesNot available PanamaAsociación Panameña de Gastroenterología y Endoscopía DigestivaYesNot available PeruAsociación Peruana de HepatologíaYesNot available Puerto RicoAsociación Puertorriqueña de GastroenterologíaYesNot available Republica DominicanaSociedad Dominicana de GastroenterologíaYesNot available UruguaySociedad de Gastroenterología del UruguayYesNot available VenezuelaSección Hepatología de Sociedad Venezolana de GastroenterologíaYesNot available CanadaCanadian Association of GastroenterologyYesNot available CanadaCanadian Association for the Study of the LiverYesNot availableAsia-Pacific region AustraliaAustralasian Hepatology AssociationYesNot available AustraliaGastroenterological Society of AustraliaYesMarch 19, 2020https://www.gesa.org.au/resources/covid-19 ChinaChinese Society of GastroenterologyYesNot available SingaporeGastroenterological Society of SingaporeYesNot available ThailandThe Gastroenterological Association of ThailandNoNot available ThailandThai Association for the Study of the LiverYesNot available PhilippinesHepatology Society of the PhilippinesYesNot available Hong KongThe Hong Kong Society of GastroenterologyYesNot available IndiaIndian National Association for Study of the LiverYesMarch 23, 2020http://www.inasl.org.in/covid19.php IndonesiaIndonesian Association for the Study of the LiverYesNot available South KoreaKorean Society of GastroenterologyYesNot available MalaysiaMalaysian Liver FoundationNoNot available MalaysiaMalaysian Society of Gastroenterology and HepatologyYesNot available NepalNepalese Association for the Studies of the LiverYesNot available New ZealandNew Zealand Society of Gastroenterology, IncYesMarch 31, 2020https://nzsg.org.nz/news-and-events/article/3485 PakistanPakistan Society for the Study of Liver DiseasesYesNot reportedhttps://pssld.com.pk/zaigham-COVID_PSSLD.pdf PakistanPakistan Society of Gastroenterology and GI EndoscopyNoNot available Sri LankaSri Lanka Society of GastroenterologyYesNot available South AsiaSouth Asian Association for the Study of the LiverYesNot availableAfrica AlgeriaSociété Algérienne d'Hépato-gastro-entérologie et d'Endoscopie digestiveYesMarch 15, 2020https://sahgeed.com/upload/COVID-19-SAHGEED.pdf EgyptEgyptian Association for Research and Training in HepatogastroenterologyNoNot available EgyptEgyptian Association for the Study of Gastrointestinal and Liver DiseaseNoNot available MoroccoSociété Marocaine des Maladies de l'Appareil DigestifNoNot available Open table in a new tab NOTE. The Belgian Association for the Study of the Liver (Belgium) and the Sociedade Brasileira de Hepatologia (Brazil) recommended continuing performing liver transplantation for all patients; the European Association for the Study of the Liver/American Association for the Study of Liver Diseases (International), British Society of Gastroenterology/British Association for the Study of the Liver (United Kingdom), and the New Zealand Society of Gastroenterology (New Zealand) recommended performing liver transplantation only for life-threatening situations, such as HCC and acute liver failure. HCC, hepatocellular carcinoma; NR, not reported; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. ALEH, Asociacion Latinoamericana para el Estudio del Higado; APASL, Asian Pacific Association for the Study of the Liver; EASL, European Association for the Study of the Liver; UEG, United European Gastroenterology. Health Status of Patients Who Underwent Liver Transplantation During the Coronavirus Outbreak at a Large Center in Milan, ItalyClinical Gastroenterology and HepatologyVol. 18Issue 9PreviewSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was declared a pandemic by the World Health Organization on March 11, 2020.1 This virus is responsible for a clinical condition, defined as coronavirus disease 2019 (COVID-19), with a clinical spectrum from mild respiratory and/or gastrointestinal symptoms to interstitial pneumonia with acute respiratory distress syndrome, possible multiorgan failure, and death.2 COVID-19 severity directly correlates with patient's age and presence of comorbidities. Full-Text PDF