Shifting perspectives in liver diseases after kidney transplantation

Abstract

Liver diseases after kidney transplantation range from mild biochemical abnormalities to severe hepatitis or cirrhosis. The causes are diverse and mainly associated with hepatotropic viruses, drug toxicity and metabolic disorders. Over the past decade, the aetiology of liver disease in kidney recipients has changed significantly. These relates to the use of direct-acting antiviral agents against hepatitis C virus, the increasing availability of vaccination against hepatitis B and a better understanding of drug-induced hepatotoxicity. In addition, the emergence of the severe acute respiratory syndrome coronavirus 2 pandemic has brought new challenges to kidney recipients. This review aims to provide healthcare professionals with a comprehensive understanding of recent advances in the management of liver complications in kidney recipients and to enable them to make informed decisions regarding the risks and impact of liver disease in this population.

Keywords: COVID-19; Drug-induced liver injury; Kidney transplantation; Non-alcoholic fatty liver disease; Viral hepatitis.

Figure 1

Progress achieved to date and high priority topics in four main types of liver diseases affecting patients after kidney transplantation. NAFLD: Non-alcoholic fatty liver disease; CNIs: Calcineurin inhibitors; DAAs: Direct acting antivirals; HCV D+/R-: Hepatits C virus donor positive/recipient negative; COVID-19: Coronavirus disease 2019; HEV: Hepatitis E virus; DILI: Drug induced liver injury; V2R: Vasopresin receptor 2; KT: Kidney transplantation; ADPKD: Autosomal dominant polycystic kidney disease.