Ninety‐Day Readmission and Morbidity Following Liver Transplantation for MASLD

TL;DR

This study compares short-term outcomes after liver transplants for MASLD versus non-MASLD and finds better results for MASLD patients despite higher comorbid risks.

Contribution

The study is the first to distinguish 90-day readmission and morbidity outcomes between liver transplant recipients with MASLD and non-MASLD etiologies.

Findings

MASLD liver transplant recipients had lower 90-day readmission and morbidity rates despite higher comorbid risks.

MASLD etiology was associated with improved outcomes in patients with class 3 obesity and liver cancer.

Chronic kidney disease, prior bariatric surgery, and COPD were predictors of 90-day morbidity in MASLD recipients.

Abstract

The incidence of short‐term (90‐day) hospital readmission and morbidity following liver transplantation (LT) for metabolic dysfunction‐associated steatotic liver disease (MASLD) is poorly characterized, and no study to date has distinguished these short‐term outcomes between MASLD and non‐MASLD LT recipients. The primary objective of this study was to leverage the National Readmissions Database (NRD) to distinguish 90‐day readmission rates and morbidity among those undergoing LT for MASLD and non‐MASLD etiologies.

Recipients undergoing LT were identified in the NRD between January 1, 2016, and December 31, 2022. Morbidity was defined as an aggregate of common surgical complications. Univariate and age‐sex adjusted quasi‐Poisson regressions were used to identify trends and differences in characteristics for patients stratified by indication for LT. Multivariable logistic regression models were used to identify factors associated with 90‐day readmissions and morbidity.

A weighted total of 58 148 LT procedures were identified, of which 11 235 (19.3%) had MASLD etiology. LT for MASLD increased over the study period, while LT for hepatitis C and liver cancer decreased. Relative to non‐MASLD LT recipients, MASLD LT recipients had increased comorbid risk profiles, including higher rates of class 3 obesity (body mass index [BMI] ≥ 40) and associated liver cancer. MASLD LT recipients had lower rates of 90‐day readmission, morbidity, and cardiovascular complications (all p < 0.05). Among patients with class 3 obesity and liver cancer, MASLD etiology was associated with improved or non‐inferior 90‐day outcomes relative to non‐MASLD LT recipients. Finally, among MASLD LT recipients, the presence of chronic kidney disease, prior bariatric surgery, dialysis, female sex, and chronic obstructive pulmonary disease were independent predictors of 90‐day morbidity and readmission.

Despite an increased comorbid risk profile, MASLD LT recipients had superior 90‐day readmission rates and morbidity outcomes relative to non‐MASLD LT recipients. MASLD etiology appears to normalize 90‐day outcomes among patients with obesity and liver cancer.

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