Recent evidence indicates that COVID-19 liver complications can emerge months after infection, particularly among patients experiencing long-COVID. Severe hepatobiliary complications, including acute hepatitis, cholestasis, autoimmune liver disease, and gallbladder pathology, have been documented following SARS-CoV-2 infection.
SARS-CoV-2 primarily targets the respiratory tract but can be associated with liver injury. Acute hepatobiliary complications may result from systemic inflammation or direct viral effects, while chronic manifestations likely involve immune dysregulation.
A systematic review analysed 23 studies reporting severe or persistent hepatobiliary conditions following COVID-19. Cases were reported from multiple countries, highlighting the global clinical relevance of these findings.
Long-COVID refers to signs, symptoms, or conditions that persist or develop at least four weeks after initial SARS-CoV-2 infection. Patients may experience relapsing-remitting or progressive liver injury, with potential outcomes such as fibrosis, cirrhosis, or in rare cases, the need for liver transplantation.
This review highlights an association between SARS-CoV-2 infection and long-term hepatobiliary complications, though causation cannot be confirmed. Variability in study design and patient populations limits definitive conclusions. Despite these limitations, the repeated documentation of severe hepatobiliary conditions across multiple settings underscores the clinical significance of potential post-COVID liver complications.
Further research is required to clarify pathophysiological mechanisms, identify high-risk populations, and determine the prevalence and progression of these complications.