Abstract
Decompensated cirrhosis secondary to metabolic dysfunction-associated steatohepatitis (MASH) is not only a common indication for liver transplant (LT) but is becoming the leading cause for LT in post-menopausal women in the United States. Given the different complex mechanisms involved in the occurrence of MASH, it is being recognized as the hepatic manifestation of the metabolic syndrome. There are multiple metabolic issues associated with MASH including obesity, diabetes mellitus type 2, cardiovascular disease, and chronic kidney disease which need to be addressed in the pre- and post-transplant setting for better patient outcomes. Recurrence of MASH following liver transplant can occur due to many reasons including reversal of the catabolic state seen in cirrhosis, improvement in appetite, and the effect of certain post-LT medications on the graft; however, managing recurrence can be challenging and thus urges addressing these issues prior to transplant, in addition to recognizing, and treating them in the post-transplant setting. In this review, we discuss the various metabolic issues that face patients with MASH, the medical and surgical management options available to improve outcomes and reduce chances of recurrence.
Published Version
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