Metabolic dysfunction-associated steatotic liver disease and new onset diabetes mellitus after liver transplantation

TL;DR

This study finds that liver transplant patients often develop metabolic issues like fatty liver disease and new diabetes, stressing the need for prevention.

Contribution

The study identifies MASLD and NODALT as frequent post-transplant complications and their associations with metabolic risk factors.

Findings

MASLD was diagnosed in 26% of liver transplant patients and linked to diabetes and high triglycerides.

NODALT occurred in 36% of patients and was associated with older age, longer follow-up, and MASLD.

Preventing post-transplant metabolic complications is crucial due to their high prevalence and risks.

Abstract

•After Liver Transplantation (LT), weight gain, MASLD and NODALT were frequent.•MASLD was associated with diabetes and hypertriglyceridemia post-LT.•NODALT was associated with older age, longer follow-up, body mass index and MASLD.•It is crucial to prevent post-LT metabolic complications.

After Liver Transplantation (LT), weight gain, MASLD and NODALT were frequent.

MASLD was associated with diabetes and hypertriglyceridemia post-LT.

NODALT was associated with older age, longer follow-up, body mass index and MASLD.

It is crucial to prevent post-LT metabolic complications.

After Liver Transplantation (LT), patients often gain weight and develop metabolic comorbidities. This study aimed to assess the prevalence and severity of Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) after LT and the incidence of New-Onset Diabetes After LT (NODALT).

Post-LT patients were recruited from an outpatient clinic. Hepatic ultrasound and 2D shear-wave elastography were performed.

A total of 142 patients were included, 63 % male with median age 60 (Interquartile Range [IQR] 47‒68 years). Median follow-up time post-LT was 137 (IQR 77‒205 months). MASLD was diagnosed in 26 %. Patients with MASLD exhibited a higher prevalence of central obesity (92 % vs. 68 %, p = 0.006), diabetes (65 % vs. 38 %, p = 0.005), hypertriglyceridemia (51 % vs. 26 %, p = 0.008), and metabolic syndrome (69 % vs. 41 %, p = 0.006) compared to those without MASLD. MASLD was independently associated with hypertriglyceridemia (Odds Ratio [OR = 2.80], 95 % Confidence Interval [95 % CI 1.22‒6.43], p = 0.015) and post-LT diabetes (OR = 2.65, 95 % CI 1.15‒6.10, p = 0.022). NODALT occurred in 36 % and was independently associated with older age (OR = 1.05, 95 % CI 1.01‒1.08, p = 0.01), time from LT (OR = 1.01, 95 % CI 1.003‒1.016, p = 0.006), body mass index (OR = 1.12, 95 % CI 1.02‒1.22, p = 0.02) and MASLD (OR = 2.99, 95 % CI 1.13‒7.92, p = 0.028). Advanced fibrosis occurred in 9 % of MASLD patients, which was similar from patients without MASLD.

After LT, the prevalence of MASLD was 26 % ant the incidence of NODALT was 36 %. MASLD was associated with diabetes and hypertriglyceridemia, while NODALT was linked to older age, longer follow-up post-LT and MASLD. These findings emphasize the importance of preventing post-LT metabolic complications.

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