Liver disease in kidney transplant recipients

Kidney transplant recipients can develop acute and chronic liver disease from a variety of conditions. Chronic viral hepatitis from hepatitis C is seen in increased frequency in hemodialysis patients. Genetic conditions, such as polycystic kidney disease, which lead to the need for kidney transplantation are also associated with liver diseases including congenital hepatic fibrosis and polycystic liver disease. Other conditions that can induce liver disease in this immune-suppressed population include a multitude of viral infections, as well as other systemic infections that can involve the liver. Drug induced liver injury is also seen in increased rates due to the use of poly-pharmacy, the effect of immune-suppression on drug metabolizing pathways in the liver and the potential of drug to drug interactions. Post transplant metabolic syndrome is also increased in kidney transplant recipients and this can lead to development of non-alcoholic fatty liver disease. A knowledge of the presentation of these liver diseases is essential in diagnosing the cause of liver disease as well as informing the diagnostic workup. Specific therapies for the various conditions will also be discussed in this review.