Sato-Espinoza K, Chotiprasidhi P, Liza E, Placido-Damian Z, Diaz-Ferrer J. Evolution of liver transplantation in the metabolic dysfunction-associated steatotic liver disease era: Tracking impact through time. World J Transplant 2024; 14(4): 98718 [DOI: 10.5500/wjt.v14.i4.98718]
Corresponding Author of This Article
Karina Sato-Espinoza, MD, Research Fellow, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First ST SW, Rochester, MN 55902, United States. sato.angela@mayo.edu
Research Domain of This Article
Transplantation
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Dec 18, 2024; 14(4): 98718 Published online Dec 18, 2024. doi: 10.5500/wjt.v14.i4.98718
Evolution of liver transplantation in the metabolic dysfunction-associated steatotic liver disease era: Tracking impact through time
Karina Sato-Espinoza, Perapa Chotiprasidhi, Estefanía Liza, Zuly Placido-Damian, Javier Diaz-Ferrer
Karina Sato-Espinoza, Perapa Chotiprasidhi, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN 55902, United States
Estefanía Liza, Zuly Placido-Damian, Javier Diaz-Ferrer, Hepatology Service, Department of Digestive Diseases, Hospital Nacional Edgardo Rebagliati Martins, Lima 15072, Peru
Javier Diaz-Ferrer, Medicine Faculty, Universidad San Martin de Porres, Lima 02002, Peru
Javier Diaz-Ferrer, Gastroenterology Service, Clinica Internacional, Lima 02002, Peru
Author contributions: Sato-Espinoza K, Chotiprasidhi P, Liza E, Placido-Damian Z, Diaz-Ferrer J performed the methodology, wrote, reviewed, and edited the manuscript.
Conflict-of-interest statement: No conflict of interest exists for any of the authors in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Karina Sato-Espinoza, MD, Research Fellow, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, 200 First ST SW, Rochester, MN 55902, United States. sato.angela@mayo.edu
Received: July 3, 2024 Revised: August 19, 2024 Accepted: August 23, 2024 Published online: December 18, 2024 Processing time: 78 Days and 17.2 Hours
Abstract
Liver transplantation (LT) for metabolic dysfunction-associated steatotic liver disease (MASLD) is increasing globally due to rising rates of obesity and metabolic syndrome, posing significant challenges. MASLD patients typically present with advanced age, higher body mass index (BMI), and metabolic comorbidities such as diabetes, hypertension, and dyslipidemia. Comprehensive pre-transplant evaluations are crucial for assessing surgical risks and preparing patients for transplantation. MASLD patients with higher BMI may experience longer operative times, potentially affecting intraoperative outcomes. In the months following LT, MASLD recipients face persistent challenges, including a higher incidence of metabolic syndrome and cardiovascular events compared to non-MASLD recipients. However, survival rates at 1-, 3-, and 5-years post-LT do not markedly differ from other etiologies, indicating comparable surgical outcomes. Optimizing outcomes in MASLD patients undergoing LT demands a multidisciplinary approach from pre-transplant assessment to post-transplant care. Strategies must address metabolic comorbidities, manage cardiovascular health, and monitor steatosis recurrence, which can be exacerbated by obesity and diabetes. This approach aims to mitigate long-term graft complications and mortality risks, ultimately enhancing transplant success and patient well-being. Continued research is essential to refine these approaches and meet the evolving challenges posed by MASLD as a leading indication for LT worldwide.
Core Tip: Managing liver transplantation (LT) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) presents unique challenges due to the high prevalence of obesity, diabetes, and metabolic syndrome. Pre-transplant evaluation should assess these factors to optimize patient selection and surgical outcomes. Intraoperative challenges, such as prolonged surgical times in obese MASLD patients, require careful management. Post-transplant monitoring for metabolic syndrome and cardiovascular complications is critical, as MASLD patients are at increased risk. Addressing steatosis recurrence through targeted metabolic management is crucial for long-term graft health and patient survival. A comprehensive, multidisciplinary approach is key to improving outcomes for MASLD recipients undergoing LT.
