Liver Transplant Outcomes and Complications for Metabolic- Dysfunction Associated Alcohol Related Liver Disease (MetALD)

Document Type

Conference Proceeding

Publication Date

8-1-2025

Publication Title

Am J Transplant

Abstract

Purpose: Metabolic alcohol-associated liver disease (MetALD) describes the coexistence of alcohol-associated liver disease (ALD) and metabolic dysfunction-associated steatotic liver disease (MASLD), two leading indications for liver transplantation (LT). However, the impact of this increasingly recognized dual pathology on LT recipient outcomes has not been thoroughly investigated. Our aim was to determine whether LT recipients with MetALD had less favorable postoperative outcomes than those with isolated ALD. Methods: A retrospective cross-sectional study of all patients who underwent LT for the primary indication of ALD at a high-volume academic transplant center between January 1, 2014, and September 26, 2023. Patients were stratified into 2 groups: LT recipients with isolated ALD and those with MetALD based on the presence of metabolic comorbidities. Kaplan-Meier analysis was used to compare mortality and graft survival rates between groups. Results: Of 381 LT recipients with ALD, 159 (42%) had isolated ALD, and 222 (58%) had MetALD. The MetALD group had a significantly higher median age (58 vs 50 years; p<0.001) and was predominantly female (77% vs. 45%). Comorbidities in the MetALD group included diabetes (37% vs. 0%), hyperlipidemia (23% vs 0%), hypertension (77% vs. 0%), and coronary artery disease (27% vs. 0%) (all p<0.001). Despite the greater prevalence of baseline metabolic comorbidities in the MetALD group, no significant differences in postoperative mortality was observed between groups at 1 (94% vs 96%), 3 (91% vs. 90%), or 5 years (90% vs. 88%) after LT. Furthermore, no significant differences in graft failure were observed between groups at 1 (91% vs 95%), 3 (88% vs 89%), or 5 years (99% vs 87%) after LT. Rejection rates and surgical complications were also comparable between groups. Conclusions: Despite being older and having a significantly higher prevalence of metabolic and cardiovascular comorbidities including diabetes, hyperlipidemia, hypertension, and coronary artery disease, LT recipients with MetALD demonstrated positive patient and graft survival outcomes comparable to those in patients with isolated ALD. These results highlight the value of LT as a treatment option in this complex patient population and suggest that the presence of MetALD should not preclude consideration for LT. CITATION INFORMATION: Toiv A., O'Brien H., Sarowar A., Andrews T., Jafri S. Liver Transplant Outcomes and Complications for Metabolic- Dysfunction Associated Alcohol Related Liver Disease (MetALD) AJT, Volume 25, Issue 8 Supplement 1 DISCLOSURES: A. Toiv: None.

Volume

25

Issue

8

First Page

S493

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