Recurrence of primary disease after adult liver transplant – Risk factors, early diagnosis, management, and prevention

Abstract

Liver transplantation offers a new lease of life to patients with end-stage liver disease and hepatocellular carcinoma. However, the implantation of an exogenous allograft and the accompanying immunosuppression brings in its own challenges. Moreover, the persistence of risk factors for the initial liver insult place the new graft at a higher risk of damage. With the increasing number of liver transplant along with improvement in survival post-transplant, recurrence of primary disease in liver grafts has become more common. Pre-2015, the most common disease to recur after transplant was hepatitis C. However, directly acting antivirals have nearly eliminated this problem. The greatest challenge of disease recurrence we now face are that of non-alcoholic steatohepatitis, alcohol related liver disease, and primary sclerosing cholangitis. We focus on the epidemiology and pathophysiology of recurrence of primary disease after transplant. We also discuss means of early identification, risk stratification, prevention, and management of recurrent primary disease after liver transplantation.