Outcomes from Referral to Transplant for Patients with MASLD: A California Liver Network Study

Area of Science:

• Hepatology
• Transplantation Medicine
• Metabolic Disorders

Background:

• Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) is a growing cause for liver transplantation in the US.
• Associated comorbidities in MASLD recipients require examination of transplant evaluation pathways and outcomes.

Purpose of the Study:

• To compare liver transplant evaluation timelines, listing rates, and outcomes between MASLD and non-MASLD patients.
• To identify unique challenges faced by MASLD patients in the liver transplant evaluation process.

Main Methods:

• Retrospective cohort analysis of 6709 adult liver transplant evaluations from the California Liver Network (2018-2020).
• Stratification of patients by MASLD versus non-MASLD etiology.
• Comparison of demographics, comorbidities, evaluation timelines, listing rates, and post-transplant outcomes.

Main Results:

• MASLD patients were older, had higher BMI, and more metabolic comorbidities than non-MASLD patients.
• MASLD patients had higher waitlist listing rates but similar transplant rates and statistically inferior 5-year post-transplant survival.
• MASLD patients showed increased mortality post-waitlist removal, particularly due to clinical deterioration.

Conclusions:

• MASLD patients encounter significant challenges including higher comorbidities and mortality risks during transplant evaluation.
• Liver transplantation provides substantial survival benefits for MASLD patients, with outcomes comparable to non-MASLD recipients.
• Early access to liver transplantation is crucial for optimizing outcomes in MASLD candidates.