Pathological anatomy of the liver in patients who died from COVID-19 in the acute period and in the late stages after the new coronavirus infection

OBJECTIVE: A comparative analysis of morphological changes in the liver in patients who died from COVID-19 and non-communicable diseases after the new coronavirus infection. MATERIAL AND METHODS: Morphological changes in the liver were studied in 37 patients who died from COVID-19 without previous pathology or bacterial superinfection and 10 from cardiovascular diseases within 40 to 300 days after COVID-19. H&E, Van Gieson, V. Picro-Mallory were used, immunohistochemical (IHC) reactions with antibodies to S-protein of SARS-CoV-2 and receptors for angiotensin converting enzyme type 2 (ACE 2). RESULTS: S-protein of SARS-CoV-2 expression is found in cholangiocytes, vascular endothelium and mononuclear cells of portal tract infiltrate, and single hepatocytes, ACE 2 - in cholangiocytes and hepatocytes. Liver changes are consistent with the morphology of hypoxic hepatitis in combination with COVID-associated microangio-, coagulo-, and cholangiopathy. In some patients, secondary sclerosing cholangitis and liver fibrosis are formed in the outcome of the disease. CONCLUSION: The study results do not allow us to exclude the role of SARS-CoV-2 in the pathogenesis of liver damage in COVID-19. Specific features of hypoxic hepatitis in COVID-19 are microangio-, coagulo- and cholangiopathy. Many other factors, the effect of which was excluded as much as possible from the study (bacterial superinfection, hepatotoxic drugs etc.) also play a large role in the pathogenesis of its pathology in COVID-19.