The updated version of JSH Guidelines for Management of Hepatitis B Virus (HBV) Infection (version 4) and JSH Guidelines for Management of Hepatitis C Virus (HCV) Infection (version 8.1) were published in June 2022 and May 2022, respectively. The JSH Guidelines for Management of HBV Infection (version 4) present recent evidences regarding management of HBV infections pre- and post-liver transplantation, management of chronic hepatitis B in childhood, NA for the prevention of mother-to-child transmission of HBV, and difference in the risk of hepatocellular carcinoma between TDF and ETV. This version also includes update of treatment goals, strategy for patients with good or poor responses to NA therapy, the IFN and NA combination therapy, HBV reactivation in immune checkpoint inhibitors, acute hepatitis B, HBV-related acute liver failure, and HBV and HIV co-infection. Meanwhile, the JSH Guidelines for Management of HCV Infection illustrates an updated flowchart of treatment for chronic hepatitis C and compensated cirrhosis type C.

We have constructed an intra-hospital cooperation alert system for positive results of hepatitis test, operated by multiple occupations. The feature of this system is that the response to the alert is required to be reported by the predetermined template, and the warning is repeatedly given by the comedic until it is reported. To clarify the effectiveness of this system, we divided patients, who were newly positive for hepatitis C virus antibody ordered by non-gastroenterologist between September 2017 and August 2019, into two periods, and examined the intervention rate alteration. The intervention rate was significantly higher in the latter year than in the first year (88.4 % vs 98.3%, p=0.002). Our system is very useful to reliably pick up hepatitis patients and connect them to appropriate treatment in our hospital.

The patient presented with nausea, appetite loss, and fatigue. She had received two doses of Pfizer/BioNTech BNT162b2 mRNA vaccine (COMIRNATY^®) for coronavirus disease 2019 (COVID-19). Acute liver injury was noted 14 days after the first dose of the vaccine. Re-exposure through the second dose worsened the liver injury. After liver biopsy on the third day of admission, methylprednisolone (1000 mg) was administered. Liver histology showed acute hepatitis with diffuse lobular inflammation/necrosis and lymphocyte-dominant infiltration in the portal areas. The patient was diagnosed with drug-induced liver injury due to the COVID-19 vaccine based on the Digestive Disease Week Japan 2004 (DDW-J) scale, which assesses the temporal relationship, liver biopsy, and laboratory findings. With improvements in the blood test parameters, prednisolone was gradually tapered and stopped. One month later, no biochemical signs of relapse were noted. To our knowledge, this is the first report describing liver injury after the administration of the Pfizer COVID-19 vaccine in Japan.

We describe our experience with COVID-19 after pediatric liver transplantation (LT). In this study, we analyzed 18 of 196 children who contracted COVID-19 after LT during outpatient follow-up at our department. The severity of COVID-19 was mild in all cases, and all cases were cured without sequelae. COVID-19 after LT in children may have a high risk of severe disease. However, the disease is relatively mild and may be cured.