Limit nosocomial transmission |
Prioritize patients to limit in‐person care
On arrival, screen patients for COVID‐19 symptoms, exposures; if suggestive of COVID‐19, refer care per clinic’s protocol for symptomatic patients
Use telemedicine alternatives for routine care
Reduce routine laboratory and imaging monitoring
Prescribe 90 days of medications
Cancel all elective/nonurgent endoscopic procedures and biopsies
Limit in‐clinic evaluations for transplant
Limit clinical trial activity to essential clinical trials
Limit HCWs providing care or on patient rounds
HCWs follow recommendations for PPE
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Use telemedicine alternatives for routine care
Minimize number of HCWs caring for patients
Minimize number of HCWs on patient rounds
Cancel elective, nonurgent endoscopies and liver biopsies
HCWs follow recommendations for PPE
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Limit in‐person care to urgent cases
Remodel clinic space for social distancing
Use telemedicine for routine care; postpone specialist visits
Reduce frequency of laboratory monitoring and obtain locally
HCWs follow recommendations for PPE
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Evaluate and care for patients with COVID‐19 for liver disease |
Prioritize for COVID‐19 testing: (1) patients with cirrhosis, (2) patients with CLD receiving immunosuppressive medications, and (3) patients with new‐onset encephalopathy or other acute decompensation
Regularly monitor liver biochemistries
Consider non‐COVID‐19 etiologies for liver disease: (1) exacerbation of preexisting CLD or (2) drug‐induced hepatotoxicity
Use acetaminophen 2 g/day as preferred medication
Use nonsteroidal anti‐inflammatory drugs as needed
Consult the University of Liverpool document to assess possible drug interactions
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Follow WHO guidelines for COVID‐19 diagnosis
Consider NAFLD as a prognostic factor for severe COVID‐19
Screen patients for hepatitis B surface antigen
Consider HBV prophylaxis prior to use of anti‐IL‐6, other immunosuppressive therapy
Monitor liver function tests of patients with CLD
Be alert to possible drug hepatotoxicity
Decompensated CLD and ALT >5 times ULD contraindications for remdesivir therapy
Prioritize persons with CLD for clinical trials
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Test for COVID‐19 patients with acute decompensation or acute‐on‐chronic liver and per institution’s practices
Persons with NAFLD likely to have comorbidity risk factors for severe COVID‐19
Consider patients with CLD/COVID‐19 for early admission and clinical trial
Use acetaminophen (2–3 g/day is generally safe)
Limit use of nonsteroidal anti‐inflammatory drugs
Test for COVID‐19 patients with acute decompensation or acute‐on‐chronic liver and per institution’s practices
Persons with NAFLD likely to have comorbidity risk factors for severe COVID‐19
Consider patients with CLD/COVID‐19 for early admission and clinical trial
Use acetaminophen (2–3 g/day is generally safe)
Limit use of nonsteroidal anti‐inflammatory drugs
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Manage hepatitis B; hepatitis C |
Continue HBV and HCV treatment of patients with COVID‐19
Proceed with HBV and HCV treatment in patients without COVID‐19 as clinically warranted
Do not consider HBV treatment in patients with COVID‐19 unless flare is suspected
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Continue HBV and HCV treatment of patients with COVID‐19
Proceed with HBV and HCV treatment in patients without COVID‐19 as clinically warranted
Do not consider HBV treatment in patients with COVID‐19 unless flare is suspected
Document discussion with patient regarding CLD diagnosis and management
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Manage patients with HCC |
Continue HCC surveillance schedule for high‐risk subjects; 2‐month delay is acceptable
Document discussion of risks and benefits of delaying surveillance with patient
Proceed with HCC treatments as appropriate
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Continue therapy for non‐COVID‐19 patients
For patients with HCC with COVID‐19, postpone elective transplant and resection surgery, withhold immunotherapy
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Maintain care per guidelines
Admit early if COVID‐19 is diagnosed
Consider postponing HCC therapies
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Manage pretransplant and posttransplant patients |
Screen donors and recipient for COVID‐19
Do not postpone transplants (an essential medical service, CMS Tier 3b)
Notify patients of possible extended waiting times on transplant list
Have low threshold for admitting patients on transplant waiting list diagnosed with COVID‐19
For posttransplant patients with moderate COVID‐19, consider reduction of immunosuppression therapy as appropriate
Do not reduce immunosuppressive therapy in patients with mild COVID‐19 disease
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Test donors and recipient for COVID‐19
Limit transplant listing to emergency and urgent cases
Look for SARS‐COV‐2 prior to organ procurement; defer donors with evidence of infection
Consider specific COVD‐19 consent for patients on transplant waiting list
For posttransplant patient with moderate COVID‐19, consider reduction of immunosuppression therapy as appropriate
Do not reduce immunosuppressive therapy in patients with mild COVID‐19 disease
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Maintain care per guidelines
Limit transplantation listings to patients with poor short‐term prognosis
Vaccinate against pneumonia and flu
Avoid reductions in immunosuppressive therapy
Do not reduce immunosuppressive therapy in patients with mild COVID‐19
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