The Impact of Metabolic Health and Obesity on Liver Transplant Candidates and Recipients

Abstract

Poor metabolic health and obesity have significant impacts on the outcomes of patients suffering from chronic liver disease, particularly those with metabolic dysfunction-associated steatotic liver disease. Patients with such comorbidities who require liver transplant evaluation for advancing liver disease or liver failure require special consideration due to increased risk of cardiovascular disease, renal dysfunction, sarcopenic obesity, and cancer. Those who have had a history of prior bariatric surgery pose specific anatomical constraints and may also be at increased risk of alcohol use disorder. Pre-operative risk assessment as well as strict control of metabolic risk factors are essential to reduce intra-operative and post-liver transplant complications. As immunosuppressive therapy exacerbates metabolic dysfunction and risk for cancer, post-liver transplant care must focus on balancing the need to prevent rejection and the impact of progressive metabolic dysfunction in this unique, but growing, patient population.

Keywords: fatty liver; liver transplantation; metabolic dysfunction; steatotic liver disease.

Figure 1

Schematic of simultaneous liver transplant (gray) and sleeve gastrectomy with excised gastric remnant (orange). Clinical considerations in the patient with obesity or post-bariatric liver transplant patient.