Metabolic associated steatotic liver disease in renal transplant recipients: a retrospective cohort study

Metabolic associated steatotic liver disease (MASLD) is a major contributor to chronic liver disease, with rising prevalence. Chronic kidney disease (CKD) shares risk factors with MASLD, including obesity, diabetes, hypertension, and metabolic syndrome. CKD prevalence in MASLD patients ranges from 4 to 40%. The interplay between MASLD and CKD may influence disease progression through intestinal barrier changes, uremic toxins, and glucocorticoid metabolism. Limited data exist on steatosis in renal transplant recipients and its impact on cardiovascular disease (CVD). This study investigates the prevalence and factors associated with steatosis and liver stiffness in kidney transplant patients, and secondarily its relationship with CVD history. Two hundred kidney transplant patients at Salerno University Hospital were studied. The data included demographics, clinical and laboratory findings, abdominal ultrasonography (US), liver stiffness, and controlled attenuation parameter (CAP). Cardiovascular disease (CVD) history was also recorded. Statistical significance was set at p < 0.05. Of the cohort, 69% were male, with a mean age of 56.8 years. Steatosis was found in 45.5%, with 11.1% at risk of fibrosis. Steatosis was associated with higher BMI (28.5 vs. 25.5, p = 0.0001) and metabolic syndrome (30.8% vs. 11.0%, p = 0.001). CAP was linked to self-reported male gender and eGFR (p < 0.05), while fibrosis correlated with age, self-reported male gender, and HDL < 40 mg/dL. CVD prevalence was 14.5%, with no significant association with steatosis. MASLD and metabolic syndrome were highly prevalent in kidney transplant recipients, though no significant link was found between steatosis and CVD history.