De novo and recurrence of metabolic dysfunction-associated fatty liver disease after liver transplantation

Table 1 Summary management strategies

Lifestyle modifications	Dietary modification
	Exercise/ physical activity
	Avoid heavy alcohol consumption
	Benefit with coffee consumption
Pharmacotherapy	No approved drug for MAFLD in post liver transplants patients
Bariatric treatment	Surgery
	Endoscopic
Tailored Immunosuppression	Early taper of steroids
	Decreasing CNIs as possible
	Avoid/cautious use of mTOR inhibitors

CNIs: Calcineurin inhibitors; MAFLD: Metabolic dysfunction-associated fatty liver disease.

Table 2 Summary of clinical significances and outcomes of de novo and recurrent metabolic dysfunction-associated fatty liver disease in post liver transplant patients

	De novo MAFLD	Recurrent MAFLD
Risk factors/Predictors for post LT MAFLD	Post LT weight gain	Post LT weight gain
	HCV	Post-transplant hypertriglyceridemia
	Sirolimus-based immunosuppressant therapy	Steroid
	Insulin resistance/diabetes mellitus	Post LT Metabolic syndrome
		Insulin use
		Insulin resistance/ diabetes mellitus
Progression to steatohepatitis and advanced fibrosis	Less common	More common
Cardiovascular events	Common	Common
Patient and graft survival	No significant impact	No significant impact

LT: Liver transplant; HCV: Hepatitis C virus; MAFLD: Metabolic dysfunction-associated fatty liver disease.