The Relentless Progression of Metabolic Dysfunction-associated Steatotic Liver Disease in Liver Transplantation in...

Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a significant indication for liver transplantation (LT) in North America. Yet data on its impact in other countries, such as Spain, remain limited. This study aimed to evaluate the prevalence and trajectory of MASLD-related LT in Spain and compare these findings with broader national data and international data sets.

Multicenter retrospective cohort study including adults (18 y and older) undergoing LT for MASLD between 2010 and 2023 in 5 large Spanish centers. Additional data were obtained from the Spanish Transplant Registry (Organización Nacional de Trasplantes) and high-prevalence LT centers in the United States (n = 7) and Canada (n = 1).

Among 3448 LTs performed in the 5 Spanish centers, 3.4% (n = 117) were MASLD-related. An increasing trajectory of MASLD-related LT was observed, with predictions suggesting a rise to 5.4%-10.8% of LTs for MASLD by 2028. These trends were consistent with Organización Nacional de Trasplantes data. Compared with North American data, the growth trajectory in Spain showed a less steep increase. Hepatocellular carcinoma rates were higher in the Spanish MASLD-LT recipients, yet metabolic comorbidities were frequent in all populations.

The burden of MASLD-related LT in Spain is growing, yet at a less pronounced rate than in the United States/Canada. Whether this slower increase will persist or decline in the future as newer antiobesity and MASLD-related drugs are increasingly used is still unknown. In the meantime, our results highlight the need for tailored approaches to management and prevention in the Spanish population and underscore the importance of continued monitoring and research into the evolving impact of MASLD on LT in Spain and beyond.