Di Giorgio Angelo, Hartleif Steffen, Warner Suzan, Kelly Deirdre
Paediatric Liver, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy.
Paediatric Gastroenterology and Hepatology, University Children's Hospital, University of Tübingen, Tübingen, Germany.
Front Pediatr. 2021 Mar 11;9:616381. doi: 10.3389/fped.2021.616381. eCollection 2021.
The global pandemic caused by novel Coronavirus SARS-CoV-2 disease (COVID-19) is a major threat to the general population and for patients with pre-existing chronic conditions. We report data concerning SARS-CoV-2 infection in children with chronic liver disease (CLD). A literature review using the online database PubMed was performed to summarize available findings on the association between pre-existing liver disease and COVID-19 infection in children. Children with COVID-19 have preserved effector and immunosuppressive components resulting in a milder disease compared to adults. The most common hepatic manifestation is an elevation of hepatic transaminases. Liver damage may be directly caused by viral infection of liver cells, by medications or by the chronic hypoxia seen in COVID-19 patients. A multicenter study reported that the majority of children with a CLD remained healthy during the outbreak. Similarly, studies reported that children on immunosuppressive treatment, including patients with autoimmune liver disease (AILD) and liver transplantation (LT), maintained good health during the outbreak without experiencing major complications even if infected with COVID-19. COVID-19-related liver injury presents with a mild elevation of transaminases, although its clinical significance is unclear. Children with CLD, including those with AILD and post-LT, do not have an increased risk for severe disease course of SARS-CoV-2 infection with little or no liver dysfunction. These data highlight the necessity to ensure normal standards of care while adhering to national Covid-19 guidelines, and particularly to maintain immunosuppressive medication to prevent relapse or rejection. Further research is required to evaluate the differences in clinical course between immunosuppressed adults and children and in particular whether asymptomatic infection is a concern.
新型冠状病毒SARS-CoV-2疾病（COVID-19）引发的全球大流行对普通人群以及患有慢性基础疾病的患者构成了重大威胁。我们报告了有关慢性肝病（CLD）儿童感染SARS-CoV-2的数据。通过在线数据库PubMed进行了文献综述，以总结关于儿童既往肝病与COVID-19感染之间关联的现有研究结果。与成人相比，感染COVID-19的儿童保留了效应和免疫抑制成分，导致病情较轻。最常见的肝脏表现是肝转氨酶升高。肝损伤可能直接由肝细胞的病毒感染、药物或COVID-19患者中出现的慢性缺氧引起。一项多中心研究报告称，大多数CLD儿童在疫情爆发期间保持健康。同样，研究报告称，接受免疫抑制治疗的儿童，包括自身免疫性肝病（AILD）和肝移植（LT）患者，在疫情爆发期间即使感染了COVID-19也保持良好健康，未出现重大并发症。COVID-19相关肝损伤表现为转氨酶轻度升高，但其临床意义尚不清楚。CLD儿童，包括AILD儿童和LT术后儿童，感染SARS-CoV-2且肝功能很少或没有异常时，发生重症病程的风险并未增加。这些数据凸显了在遵循国家COVID-19指南的同时确保正常护理标准的必要性，特别是维持免疫抑制药物治疗以防止复发或排斥反应。需要进一步研究以评估免疫抑制的成人和儿童在临床病程上的差异，尤其是无症状感染是否值得关注。
