Liver Histopathology in COVID-19 Infection Is Suggestive of Vascular Alteration

Abstract

Background: COVID-19 breakout in Italy caused a huge number of severely ill patients with a serious increase in mortality. Although lungs seem to be the main target of the infection very few information are available about liver involvement, possibly evocating a systemic disease. Methods: Post-mortem wedge liver biopsies from 48 patients died for COVID-19 infection were collected from two main hospitals in the north of Italy: all samples were obtained during autopsies. No patient had clinical symptoms of liver disease or signs of liver failure before and during hospitalization; for each of them liver function tests were available. Findings: All liver samples showed minimal inflammation features. Histological pictures compatible with vascular alterations were observed, characterized by increase of number of portal vein branches associated with lumen massive dilatation, partial or complete luminal thrombosis of portal and sinusoidal vessels, fibrosis of portal tract, focally markedly enlarged and fibrotic. Interpretation: Our preliminary results confirm the clinical impression that liver failure is not a main concern and this organ is not the target of significant inflammatory damage. Histopathological findings are highly suggestive for marked derangement of intrahepatic blood vessel network secondary to systemic changes induced by virus that could target not only lung parenchyma but also cardiovascular system, coagulation cascade and endothelial layer of blood vessels. Funding Statement: This work has no financial support. Declaration of Interests: None of the authors declare a conflict of interest Ethics Approval Statement: This work is based exclusively on routine file autoptic material and is ethical approval exempt to use anonymous data. The study followed the Italian general rules used for research related to scientific purposes (official regulations n.72-26 /03/2012).