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

Introduction and objectives:  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).

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

Results:  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.

Conclusion:  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.

Keywords
Liver Transplantation; Nonalcoholic Fatty Liver Disease; Metabolic Dysfunction-Associated Steatotic Liver Disease; Fatty Liver; Post-Transplant Diabetes; Insulin Resistance; Metabolic Syndrome; Ultrasound; Hepatic elastography