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Rapid-Fire Presentation

Post-transplant MASLD does not adversely affect long-term survival or cardiometabolic outcomes following liver transplantation

Presenter
Ki Sang Jung (KR)

Fellow · Department of Surgery, Transplant division · Samsung Medical Center · Seoul

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Authors

Ki Sang Jung1, Suk Min Gwon1, Goeun Park2, Jongman Kim1, Jiyoung Baik1, Hayeon Do1, Namkee Oh1, Jinsoo Rhu1, Wonseok Kang3, Woo Kyoung Jeong4, Kyunga Kim2, Gyu Seong Choi1, Jae Won Joh1

Affiliations

1 Samsung Medical Center
2 Samsung Medical Center
3 Samsung Medical Center
4 Samsung Medical Center

Abstract

Introduction: Metabolic dysfunction–associated steatotic liver disease (MASLD) is increasingly recognized after liver transplantation, yet its long-term clinical implications remain unclear. We aimed to assess the incidence, risk factors, and prognostic significance of post-transplant MASLD in a substantial cohort with prolonged follow-up.
Methods: A retrospective analysis was conducted in 355 adult liver transplant recipients, including 233 non-MASLD and 122 MASLD patients. A comparison was made of clinical features, laboratory values, and long-term results. Kaplan–Meier methods were used to look at incidence curves and overall survival. Risk factors for MASLD, mortality, cardiovascular events, chronic kidney disease (CKD), and de novo malignancy were identified using logistic regression.
Results: The incidence of MASLD rose progressively, attaining 27.9% at 5 years, 37.3% at 10 years, and 43.6% at 15 years. The only independent predictor of MASLD was alcohol-related liver disease. Overall survival rates were similar between the two groups (15-year survival: 86.0% vs. 81.5%; P=0.180).

Figure 1
Post-transplant MASLD: Cumulative incidence and overall survival. (A) Cumulative incidence of MASLD after liver transplantation. (B) Comparison of cumulative overall survival rates between the MASLD and no-MASLD groups.
Although the incidence of heart failure was higher in the MASLD group (7.4% vs. 2.6%, P=0.033), MASLD was not an independent risk factor for major adverse cardiovascular events (MACE), de novo malignancy, or mortality. Notably, MASLD was independently associated with a reduced risk of CKD stage ≥III (OR 0.749, P=0.040)
Figure 2
Cumulative incidence of long-term complications according to MASLD status. Comparison of cumulative incidences of (A) major adverse cardiovascular events (MACE), (B) chronic kidney disease (CKD), and (C) de novo malignancy after liver transplantation between the MASLD and no-MASLD groups.
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Conclusion: Post-transplant MASLD is common but, in this cohort with rigorous long-term follow-up, did not adversely impact overall survival. These results suggest that management of liver transplant recipients should prioritize personalized metabolic monitoring and cardiovascular risk factor control, rather than relying on MASLD diagnosis alone for aggressive risk stratification.