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, highlighting the importance of vigilant post-infection monitoring.
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.
Cases Across Global Regions
A systematic review analysed 23 studies reporting severe or persistent hepatobiliary conditions following COVID-19. Reported cases came from multiple countries, including the USA, Germany, India, Colombia, Austria, Turkey, Iran, Israel, Mexico, Egypt, Poland, Brazil, and Hungary, highlighting the global clinical relevance of these findings.
Long-COVID, as defined by the US Department of Health and Human Services, refers to signs, symptoms, or conditions that persist or develop at least four weeks after initial SARS-CoV-2 infection. However, definitions of long-COVID vary across studies and organisations, with some considering symptoms lasting 8–12 weeks or longer, which may influence how post-COVID hepatobiliary complications are reported. 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.
Study Methods and Scope
Inclusion criteria focused on severe or long-term hepatobiliary complications occurring beyond 12 weeks post-COVID infection. Cases of transient liver injury resolving within 12 weeks were excluded. This methodological approach ensured that the review concentrated on clinically significant long-term outcomes.
Research Gaps and Emerging Patterns
This review highlights an association between SARS-CoV-2 infection and long-term hepatobiliary complications, though causation cannot be confirmed. Variability in study design, geographic distribution, and patient populations limits definitive conclusions about incidence of post-COVID hepatobiliary complications. 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. These knowledge gaps point to the need for larger, multicentre studies to better characterise long-term outcomes across therapeutic areas following COVID-19 infection.
References
Aboulwafa A et al. New onset of severe and long-term hepatobiliary diseases post-COVID-19 infection: a systematic review. BMC Infect Dis. 2026;253(26):1-16.
World Health Organisation (WHO) European Region. Post COVID-10 condition (Long COVID). Available at: https://www.who.int/europe/news-room/fact-sheets/item/post-covid-19-condition. Last accessed: 5 March 2026.
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