De novo and recurrence of metabolic dysfunction-associated fatty liver disease after liver transplantation

Abstract

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a new acronym adopted from the consensus of international experts. Given the increasing prevalence of MAFLD in pre-transplant settings, de novo and recurrent graft steatosis/MAFLD are common in post-transplant settings. The impact of graft steatosis on long-term outcomes is unclear. The current knowledge of incidence rate, risk factors, diagnosis, long-term outcomes, and management of graft steatosis (both de novo and recurrent) is discussed in this review.

MAFLD: an optimal framework for understanding liver cancer phenotypes

“…Amongst patients who receive a liver transplant for HCC, MAFLD is an increasingly common cause of underlying liver disease, increasing from 1.3% in 2002–2004 to 8.3% from 2014–2016 in a European registry study [ 146 ]. There were no significant differences in post liver transplant survival outcomes or graft survival outcomes between MAFLD and non-MAFLD recipients reported, either for recipients with or without HCC [ 146 ] although recurrence of MAFLD is known to be common post-transplant [ 147 ]. A United Network for Organ Sharing (UNOS) database did report superior overall survival in patients transplanted for MAFLD, however, in the sub-population who received transplant for HCC, there was no difference in overall survival by liver disease aetiology [ 148 ].…”

Metabolic Disorders in Liver Transplant Recipients: The State of the Art

“…The condition affects approximately 25% of the general population [87], and as mentioned earlier, cirrhosis related to it is becoming the leading cause of liver transplantation [8]. The development of de novo MASL or recurrent graft steatosis is relatively common in LT recipients [88]. In detail, after 5 years from LT, recurrent graft steatosis and NASH may be present in approximately 80% and 60% of patients transplanted for NASH cirrhosis, respectively.…”

Post-Transplant Hepatic Steatosis: A Condition Not to Overlook

“…Weight loss drugs are commonly used in overweight or obese patients with NAFLD. Other than orlistat, no other oral weight loss agents have been studied in LT recipients [18]. Newer medications, like glucagon-like peptide 1 (GLP-1) agonists, have shown promising results and have led to significant weight loss, improvement in liver transaminases, and steatosis stage when studied in non-transplant patients with NAFLD but are not yet approved [19].…”

“…Currently, data on the utility of GLP-1 agonists in patients with post-LT steatosis are lacking, but this is subject to change as these medications undergo more widespread use. Surgical or endoscopic bariatric interventions can also be considered in carefully selected LT patients [18]. Finally, close follow-up with initiation or maintenance of guideline-based drugs for management of type 2 diabetes, hypertension, and dyslipidemia is essential.…”

“…Tailored strategies to reduce the risk of post-LT metabolic syndrome and hepatic steatosis from immunosuppressive medications are also important to optimize long-term patient and graft survival [14,18]. Early steroid tapering and minimizing the use of calcineurin inhibitors by using alternative agents can aid glycemic control in diabetic LT patients [14].…”