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. 2020 May 21;15(5):204–209. doi: 10.1002/cld.972

Table 1.

Selected AASLD, APASL, and EASL Recommendations for Liver Disease Management During the COVID‐19 Pandemic

Recommendations AASLD APASL EASL
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

  • 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

  • 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

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

  • 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

  • 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

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

  • 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

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

  • Continue therapy for non‐COVID‐19 patients

  • For patients with HCC with COVID‐19, postpone elective transplant and resection surgery, withhold immunotherapy

  • Maintain care per guidelines

  • Admit early if COVID‐19 is diagnosed

  • Consider postponing HCC therapies

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

  • 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

  • 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