Metabolic dysfunction-associated steatotic liver disease... : European Journal of Gastroenterology & Hepatology (original) (raw)

Original articles: Hepatology

Metabolic dysfunction-associated steatotic liver disease correlates with higher lower graft survival in liver transplant recipients with hepatocellular carcinoma

Alsaqa, Marwana; Sierra, Leandroa; Marenco-Flores, Anaa; Parraga, Ximenaa; Barba, Romeliab; Goyes, Danielac; Ozturk, N. Begumd; Curry, Michael P.a; Bonder, Alana; Saberi, Behnama

aDivision of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts

bDepartment of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas

cDivision of Digestive Diseases, Yale School of Medicine, New Haven, Connecticut

dDepartment of Internal Medicine, Beaumont Hospital, Royal Oak, Michigan, USA

Received 28 July 2024 Accepted 1 December 2024.

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website, www.eurojgh.com.

Correspondence to Behnam Saberi, MD, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, 375 Longwood Ave, Room 425, Boston, MA 02215, USA, Tel: +1 617 632 1070; e-mail: [email protected]

European Journal of Gastroenterology & Hepatology 37(4):p 497-504, April 2025. | DOI: 10.1097/MEG.0000000000002914

Background

Direct-acting antivirals (DAAs) have revolutionized hepatitis C virus (HCV) treatment. The changing landscape of hepatocellular carcinoma (HCC) in liver transplant (LT) recipients lacks a thorough description of the outcomes of HCC based on etiology.

Objective

To assess the waitlist (WL) dropout and graft survival in HCC LT candidates based on the etiology of HCC in the post-DAA era.

Methods

This retrospective cohort study analyzed United Network Organ Sharing/Organ Procurement Transplant Network data from 2015 to 2022. Graft survival was analyzed using Kaplan–Meier curves, and predictors of WL dropout and graft failure were assessed using multivariate analysis.

Results

Among LT recipients, etiologies were HCV (53.6%), alcohol-associated liver disease (ALD) (12.0%), metabolic dysfunction-associated steatotic liver disease (MASLD) (16.6%), hepatitis B virus (HBV) (5.6%), and other (12.1%). MASLD and ALD had the highest dropout rates (1-year: 20.4%, 21.7%; 3-year: 58.2%, 51.1%; P < 0.001). Dropout was linked to diabetes, low albumin, high Model of End-Stage Liver Disease, high alpha-fetoprotein, tumor number, and size. MASLD had the worst 1-, 3-, and 5-year graft survival (89.8%, 81.8%, and 74.1%) and higher failure risk than HCV (hazard ratio: 1.143, 95% CI: 1.021–1.281). Diabetes negated MASLD’s impact on graft failure but worsened survival for MASLD-HCC compared with HBV and ALD, matching HCV.

Conclusion

MASLD has the highest WL dropout and post-LT graft failure among HCC LT candidates, surpassing HCV in the post-DAA era. The worst graft survival in MASLD-HCC is associated with pre-LT diabetes.

Plain Language SummaryThis study examined liver transplant outcomes for hepatocellular carcinoma (HCC) patients based on the cause of their liver disease in the era after direct-acting antivirals (DAAs) for hepatitis C. Data from 2015 to 2022 showed that patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-associated liver disease (ALD) had the highest rates of dropping off the transplant waitlist. MASLD patients also had the worst graft survival rates, with diabetes further worsening outcomes. These findings highlight MASLD as a significant risk factor for poor liver transplant outcomes, even more so than hepatitis C in the post-DAA era.

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