Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Thursday, 05 / 13 / 2021




Coronavirus Disease-2019 (COVID-19) and the Liver

Anshuman Elhence1 , Manas Vaishnav1 , Sagnik Biswas, Ashish Chauhan, Abhinav Anand1 and Shalimar1,*

1  Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
2  Department of Gastroenterology, Indira Gandhi Medical College, Shimla, India
*Correspondence to: Shalimar, Department of Gastroenterology, Room No 127, Human Nutrition unit, Old OT block, AIIMS, New Delhi 110029, India. ORCID: Tel: + 91-9968405815, E-mail:  This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2021;9(2):247-255 DOI: 10.14218/JCTH.2021.00006
Received: January 2, 2021 Accepted: February 26, 2021 Published online: March 22, 2021


Within a year of its emergence, coronavirus disease-2019 (COVID-19) has evolved into a pandemic. What has emerged during the past 1 year is that, apart from its potentially fatal respiratory presentation from which the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) derives its name, it presents with a myriad of gastrointestinal (GI) and liver manifestations. Expression of the angiotensin-converting enzyme-2 (ACE-2) receptor throughout the GI tract and liver, which is the receptor for the SARS-CoV-2, may be responsible for the GI and liver manifestations. Besides acting directly via the ACE-2 receptor, the virus triggers a potent immune response, which might have a role in pathogenesis. The virus leads to derangement in liver function tests in close to 50% of the patients. The impact of these derangements in patients with a normal underlying liver seems to be innocuous. Severe clinical presentations include acute decompensation and acute-on-chronic liver failure in a patient with chronic liver disease, leading to high mortality. Evolving data suggests that, contrary to intuition, liver transplant recipients and patients with autoimmune liver disease on immunosuppression do not have increased mortality. The exact mechanism underlying why immunosuppressed patients fare well as compared to other patients remains to be deciphered. With newer variants of COVID-19, which can spread faster than the original strain, the data on hepatic manifestations needs to be updated to keep a step ahead of the virus.


Transaminitis, Cirrhosis, Vaccine, ACLF

Journal of Clinical and Translational Hepatology 2021 vol. 9, 247-255  [ Html  ] [ PDF Full-text ]

© 2021 Authors. This is an Open Access article distributed under the terms of the  Creative Commons Attribution-Noncommercial 4.0 License(CC BY-NC 4.0), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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