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Since January 2020, the COVID-19 pandemic has not been out of the news. It has overwhelmed countries and healthcare systems worldwide and the scientific and medical community has responded at an unprecedented speed.

Our knowledge increases daily and today at Digital ILC was no exception. This topical session covered the latest information on the multiorgan manifestations of COVID-19, risk factors for severe disease and how pre-existing liver disease may influence the clinical course of SARS-CoV-2.

We learned that, as well as the now well-established risk factors (age, male sex, and comorbidities such as cardiovascular disease and obesity), chronic liver disease may also increase the risk of severe COVID-19. Data from the COVID-Hep and SECURE-cirrhosis registries supported this, showing a stepwise increase in rates of major adverse outcomes, including death, with increasing severity of liver disease. For patients with decompensated cirrhosis, the numbers were stark: 79% mortality among Child-Pugh C once admitted to the intensive care unit (ICU), and 90% mortality once invasive ventilation is administered in this population.

COVID-19 has had a profound impact in the setting of liver transplantation, with an abrupt drop in transplant activity coincident with the pandemic that has necessitated modification of transplant programmes, reprioritization of transplant candidates, re-evaluation of risk on an almost daily basis, and potential temporary cessation of transplantation in areas where the virus is prevalent. The key message for patients is that although those who have undergone liver transplantation are at increased risk of COVID-19 infection, disease severity appears to be in line with that in the general population. Guidelines also broadly advise against reduction of immunosuppressive therapy as this has not been demonstrated to increase risk.