Waitlist and transplant outcomes in patients with metabolic dysfunction-associated steatotic liver disease and autoimmune hepatitis

• Published in: Liver international Vol. 44; no. 11; pp. 3083 - 3095
• Main Authors: Medina-Morales, Esli, Ismail, Mohamed, Goyal, Ritik M, Marenco-Flores, Ana, Saberi, Behnam, Fricker, Zachary, Bonder, Alan, Trivedi, Hirsh D
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.11.2024
• Subjects: Ascites; Encephalopathy; Graft-versus-host reaction; Grafting; Hepatitis; Liver; Liver diseases; Liver transplantation; Metabolism; Patients; Survival; Transplantation; Transplants & implants; autoimmune hepatitis; metabolic dysfunction‐associated steatohepatitis; non‐alcoholic fatty liver disease; metabolic dysfunction‐associated steatotic liver disease; liver transplantation
• ISSN: 1478-3223; 1478-3231; 1478-3231
• DOI: 10.1111/liv.16100

Metabolic dysfunction-associated steatotic liver disease (MASLD), in the context of autoimmune hepatitis (AIH) among liver transplantation (LT) candidates or recipients remains poorly understood. This study compares waitlist and post-LT outcomes in patients with MASLD/AIH to MASLD and AIH alone. Using the united network organ sharing database (2002-2022), we compared waitlist outcomes and post-LT survival among patients with MASLD/AIH (n = 282), AIH (n = 5812), and MASLD (n = 33 331). Competing risk, Kaplan Meier estimates and Cox proportional hazard analyses were performed. MASLD/AIH group had the highest rates of encephalopathy and ascites, and highest MELD scores. MASLD/AIH patients had higher transplantation incidence (adjusted subdistribution hazard ratio [aSHR] 1.64, 95% CI 1.44-1.85; p < .001) and lower waitlist removal risk (aSHR .30, 95% CI .20-.44; p < .001) compared to MASLD alone. One-year post-LT survival favoured MASLD compared to AIH (patient: 92% vs. 91%, p < .001; graft: 89% vs. 88%, p < .001) and MASLD/AIH (patient: 92% vs. 90%, p = .008; graft: 89% vs. 88%, p = .023). Recipients with MASLD/AIH showed no significant difference in survival at 10-year post-LT compared to MASLD (patient: 63% vs. 61%, p = .68; graft 60% vs. 59%, p = .83) and AIH (patient: 63% vs. 70%, p = .07; graft: 60% vs. 64%, p = .42). Our study showed that MASLD/AIH patients demonstrate higher LT incidence and lower dropout rates. Long-term post-LT outcomes did not significantly differ between groups. Further prospective multicenter studies are needed to validate these findings.