Metabolic comorbidities and post-transplant outcomes in Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD): a cohort study from a Brazilian tertiary center.

Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease, affects approximately 38% of the global population. MASLD's strong association with obesity and type 2 diabetes positions it as an increasingly prevalent indication for liver transplantation. Hence, this study sought to assess the prevalence of MASLD as an indication for liver transplantation, to characterize the clinical and epidemiological profile of the affected population, and to investigate the rates of post-transplant recurrence and de novo occurrence. We also compared survival outcomes between recipients with MASLD and other etiologies. Materials and methods: We conducted a retrospective analysis of 610 patients listed for liver transplantation at Hospital das Clínicas (University of São Paulo) between 2005 and 2015. Data regarding demographics, comorbidities, and post-transplant outcomes were collected from medical records. The statistical analysis encompassed both descriptive and inferential methods. Results: Out of 610 patients, 61 (10%) were diagnosed with MASLD-related cirrhosis, presenting a waitlist mortality rate of 42.6%. Among the 264 who received transplants, 36 (13.6%) had MASLD as the primary diagnosis. Post-transplantation, 58 recipients developed steatosis, with 82.8% of these cases being de novo allograft steatosis. Pre-transplant obesity and hypertension were identified as significant risk factors. Importantly, patients undergoing transplantation for MASLD showed lower survival rates compared to those with other etiologies. Conclusion: MASLD patients who undergo liver transplantation exhibit distinctive clinical outcomes and reduced survival rates. These findings underscore the critical need for targeted risk assessments and developing long-term strategies to enhance the prognosis for this increasingly common patient demographic.