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Histopathological impact of SARS-CoV-2 on the liver:Cellular damage and long-term complications

World Journal of Gastroenterology 2024年第22期30卷 2866-2880页

作者： Alfonso Rodriguez-Espada Moises Salgado-de la Mora Briana Mariette Rodriguez-Paniagua nathaly limonde la rosa Monica Itzel Martinez-Gutierrez Santiago Pastrana-Brandes Nalu Navarro-Alvarez Department of Molecular Biology Universidad Panamericana School of MedicineCampus MéxicoMexico 03920Mexico Department of Internal Medicine Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico 14080Mexico Department of Surgery University of Colorado Anschutz Medical CampusDenverCO 80045United States PECEM Facultad de MedicinaUniversidad Nacional Autónoma de MéxicoMexico 04360Mexico Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico 14080Mexico

Coronavirus disease 2019(COVID-19),caused by the highly pathogenic severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),primarily impacts the respiratory tract and can lead to severe outcomes such as acute respiratory distress syndrome,multiple organ failure,and *** extensive studies on the pathogenicity of SARS-CoV-2,its impact on the hepatobiliary system remains *** liver injury is commonly indicated by reduced albumin and elevated bilirubin and transaminase levels,the exact source of this damage is not fully *** mechanisms for injury include direct cytotoxicity,collateral damage from inflammation,drug-induced liver injury,and ischemia/***,evidence often relies on blood tests with liver enzyme *** this comprehensive review,we focused solely on the different histopathological manifestations of liver injury in COVID-19 patients,drawing from liver biopsies,complete autopsies,and in vitro liver *** present evidence of the direct impact of SARS-CoV-2 on the liver,substantiated by in vitro observations of viral entry mechanisms and the actual presence of viral particles in liver samples resulting in a variety of cellular changes,including mitochondrial swelling,endoplasmic reticulum dilatation,and hepatocyte *** ly,we describe the diverse liver pathology observed during COVID-19 infection,encompassing necrosis,steatosis,cholestasis,and lobular *** also discuss the emergence of long-term complications,notably COVID-19-related secondary sclerosing *** the histopathological liver changes occurring during COVID-19 infection is pivotal for improving patient recovery and guiding decision-making.

关键词： Liver SARS-CoV-2 COVID-19 Angiotensin-converting enzyme 2 Histopathology Liver biopsies Liver autopsy In vitro

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Liver transplantation is beneficial regardless of cirrhosis stage or acute-on-chronic liver failure grade:A single-center experience

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World Journal of Gastroenterology 2022年第40期28卷 5881-5892页

作者： Eduardo Cervantes-Alvarez Mario Vilatoba nathaly Limon-de la rosa Osvely Mendez-Guerrero David Kershenobich Aldo Torre Nalu Navarro-Alvarez PECEM Facultad de MedicinaUniversidad Nacional Autónoma de MéxicoMexico City 14080Mexico Department of Gastroenterology Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico Department of Trasplant Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico Department of Molecular Biology Universidad Panamericana School of MedicineMexico City 03920Mexico Department of Surgery University of Colorado Anschutz Medical CampusDenverCO 80045United States

BACKGROUND Liver transplantation for the most critically ill remains controversial;however,it is currently the only curative treatment *** To assess immediate posttransplant outcomes and compare the short(1 year)and long-term(6 years)posttransplant survival among cirrhotic patients stratified by disease *** We included cirrhotic patients undergoing liver transplantation between 2015 and 2019 and categorized them into compensated cirrhosis(CC),decompensated cirrhosis(DC),and acute-on-chronic liver failure(ACLF).ACLF was further divided into severity *** primary outcomes of interest were total days of intensive care unit(ICU)and hospital stay,development of complications and posttransplant survival at 1 and 6 *** 235 patients underwent liver transplantation(CC=11,DC=129 and ACLF=95).Patients with ACLF had a significantly longer hospital stay[8.0(6.0-13.0)vs CC,6.0(3.0-7.0),and DC 7.0(4.5-10.0);P=0.01]and developed more infection-related complications[47(49.5%),vs CC,1(9.1%)and DC,38(29.5%);Plant survival at 1-and 6-years was similar among groups(P=0.60 and P=0.90,respectively).ACLF patients stratified according to ACLF grade[ACLF-1 n=40(42.1%),ACLF-2 n=33(34.7%)and ACLF-3 n=22(23.2%)],had similar ICU and hospital stay length(P=0.68,P=0.54),as well as comparable frequencies of overall and infectious posttransplant complications(P=0.58,P=0.80).There was no survival difference between ACLF grades at 1 year and 6 years(P=0.40 and P=0.15).CONCLUSION Patients may benefit from liver transplantation regardless of the cirrhosis *** patients have a longer hospital stay and frequency of infectious complications;however,excellent,and comparable 1 and 6-year survival rates support their enlisting and transplantation including those with ACLF-3.

关键词： Liver transplantation Acute-on-chronic liver failure Prognosis Survival analysis Critical care

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