Beyond the Lungs: Unveiling the Long-term Hepatobiliary Complications of COVID-19

Although primarily known for its respiratory involvement, SARS-CoV-2 infection has increasingly been associated with significant effects on multiple organ systems, including the hepatobiliary tract. Over the course of the pandemic, it was shown that COVID-19 can trigger a variety of liver and cholangiocyte impairments through many overlapping mechanisms. These include entry of the virus into liver cells that express angiotensin-converting enzyme 2 receptors, impaired immune responses, ischemic injury, and adverse reactions to therapeutic drugs. These may lead to persistent hepatic enzyme abnormalities, biliary stasis, secondary sclerosing cholangitis, or fibrosis. Individuals who have underlying liver disease, such as liver cirrhosis or non-alcoholic fatty liver disease (NAFLD), are especially susceptible to serious complications and unfavorable outcomes. Uncommon immune-mediated conditions, such as post-COVID-19 vaccination autoimmune-like hepatitis, have been reported. Therefore, ongoing assessment of liver function and careful long-term follow-up are recommended for patients with post-COVID-19 syndrome, especially those at high risk. This review discusses current evidence to provide an overview of the mechanisms, manifestations, and long-term consequences of COVID-19 involving the hepatobiliary tract.