Metabolic Dysfunction-Associated Steatotic Liver Disease and Kidney Transplant Outcomes

We describe the epidemiology of metabolic dysfunction-associated steatotic liver disease (MASLD) and evidence of advanced liver fibrosis by readily available noninvasive diagnostics and their implications to kidney transplant recipients (KTRs).

In this retrospective cohort study of first-time KTRs (2008-2020), we assessed the prevalence and incidence of MASLD (hepatic steatosis on abdominal ultrasound alongside ≥ 1 cardiometabolic risk factors) and advanced hepatic fibrosis (Fibrosis-4 (FIB-4) index > 2.67). We fitted multivariable time-dependent Cox regression models to assess associations between MASLD and a composite of graft dysfunction (estimated glomerular filtration rate [eGFR] < 30 mL/min per 1.73 m²), death-censored graft failure (DCGF), death with graft function (DWGF), and each distinct end point.

In 650 eligible KTRs (median age 57.2 [interquartile range {IQR}: 45.0-66.0] years, 34% female), prevalence per 100 KTR (95% confidence interval [CI]) at transplantation and 5-years post-transplant, was 21.7 (18.6-25.1) and 42.3 (38.5-46.2), respectively, for MASLD and 42.9 (39.1-46.8) and 69.7 (66.0-73.2), respectively, for advanced fibrosis. Incidence rate per 100 person-years was 5.5 (4.7-6.4) for MASLD and 2.2 (1.6-2.9) for advanced fibrosis in KTRs without MASLD and advanced fibrosis at transplantation, respectively. Adjusted hazard ratios (HR) for the composite, graft dysfunction, DCGF, and DWGF were 1.27 (0.98-1.65), 1.24 (0.86-1.78), 1.14 (0.75-1.73), and 1.56 (1.04-2.33) with versus without MASLD and 1.76 (1.14-2.71), 1.47 (0.71-3.01), 3.28 (1.78-6.06), and 1.68 (0.91-3.13) with FIB-4 > 2.67 versus FIB-4 < 1.3, respectively.

KTRs with MASLD and advanced hepatic fibrosis demonstrate lower patient and graft survival, which could be amenable to timely interventions for cardiometabolic risk reduction.