For those who want to view the actual lectures, you can sign up and view the recordings: Aspen Webinar Lecture Series
Below I’ve included a few slides and some notes; my notes may have errors of omission or transcription.
COVID-19 and the Liver — Fred Suchy
- The extent and severity of liver disease related to COVID-19 is still being determined. Many individuals have mild liver test abnormalities (5-60%)
- Avoid imaging unless it will change your management (eg. thrombus)
- In those with worsening/significant liver abnormalities, look for other etiologies of elevated liver tests (eg. other viral hepatitis, drugs, myositis, coinfection, clots, multi-system inflammatory disorder)
- Currently, no change in immunosuppression is recommended in the post-transplant population WITHOUT COVID-19. In those with severe COVID-19 infection, reduction in immunosuppression is recommended
How I Manage Patients with Autoimmune Hepatitis -Diagnosis and Treatment Amy Taylor.
- At presentation, check TPMT activity and look for other autoimmune diseases (especially thyroid, autoimmune hemolytic anemia, and celiac disease)
- Useful resource -C Mack et al Hepatology, May 2020 https://doi.org/10.1002/hep.31065 -full text link: Diagnosis and Management of Autoimmune Hepatitis in Adults and Children: 2019 Practice Guidance and Guidelines From the American Association for the Study of Liver Diseases
- Check cholangiography if not responding to treatment
- 1st line treatment: glucocorticoid with azathioprine. Azathioprine dosing can be adjusted to aim for 6-TGN level 100-300.
- 2nd line treatment: mycophenilate mofitil (MMF). 3rd line treatment: calcineurin inhibitor
- Investigational therapies: infliximab, rituximab, regulatory T-cells