Gastrointestinal and hepatic manifestations of COVID-19 infection: Lessons for practitioners

Table 9 Expert guidance on immunosuppression for liver disease in the setting of coronavirus disease 2019[168]

	Selected recommendations from AASLD and EASL on use of immunosuppressive therapies in CLD patients
	(1) Initiating corticosteroids and immunosuppressive therapy should be preceded; and (2) by careful risk vs benefit assessment.
Patients uninfected by COVID-19 on immunosuppressive therapy	Dosage reductions or adjustment is not advised.
Patients infected with COVID-19 on immunosuppressive therapy	(1) Corticosteroid dose reductions after specialist consultation (consider tapering to avoid adrenal insufficiency); and (2) Dose reductions in azathioprine, cyclosporine, mycophenolate is recommended in severe COVID-19 (especially with accompanying lymphopenia).
Patients requiring initiation of immunosuppressive therapy	Initiating treatment is recommended in these patients regardless of COVID-19 status.

AASLD: American Association for the Study of Liver Diseases; EASL: European Association for the Study of the Liver; CLD: Chronic liver disease; COVID-19: Coronavirus disease 2019.