Association between metabolic dysfunction-associated steatohepatitis and mortality in organ transplant recipients

Published in the peer-reviewed journal Transplantation Proceedings, a University of Minnesota Medical School research team found that non-liver solid organ transplant recipient patients who develop metabolic dysfunction-associated steatohepatitis (MASH) had a higher risk of death compared to patients who did not develop MASH.

MASH is a condition that occurs when there is an accumulation of fat in the liver, which then leads to inflammation and potential damage. This predisposes the liver to scarring and, in some cases, progression to cirrhosis. Patients who develop fatty liver and inflammation tend to have worse health outcomes, usually in terms of cardiovascular disease and mortality.

In some cases, metabolic dysfunction-associated steatotic liver disease (MASLD) can lead to MASH. MASH, in turn, can lead to cirrhosis—which is why early identification is important.

"Doctors who take care of post-transplant patients should be on the lookout for MASLD," said Nicholas Lim, MD, an associate professor of medicine at the U of M Medical School and hepatologist with M Health Fairview. "It's important to identify post-transplant patients who are at high risk of developing MASH because our study shows that these patients have a higher risk of death."

The retrospective analysis found:

• Development of MASH post-transplant was found to be significantly associated with higher mortality compared with those who do not develop MASH.
• MASH was not significantly associated with major adverse cardiovascular events (MACE)—the composite outcome of coronary artery disease, ischemic stroke and peripheral arterial disease in transplant patients.

"It's unusual that MASH did not seem to affect the risk of cardiac events, as we typically see increased risk in this patient population," Dr. Lim said. "This underscores the importance of studies like ours. It is possible that transplant patients who develop MASH are instead at increased risk for other things that can lead to death, such as cancer and infection, which we will only identify through further research."