A tale of two diseases: ALD and MASLD requirements and monitoring for liver transplantation.
Academic Article
Overview
abstract
The requirements for eligibility and monitoring before and after liver transplantation for alcohol-associated liver disease (ALD) and metabolic dysfunction-associated steatotic liver disease (MASLD) are different and not as well defined for MASLD as they are for ALD. Two groups of patients with ALD considered for liver transplant include those with decompensated cirrhosis from alcohol and those with severe alcohol-associated hepatitis. Both groups are required to commit to lifelong abstinence from alcohol. Pre-transplant eligibility criteria for liver transplant in those with ALD varies between transplant centers, but generally, a period of alcohol abstinence with or without counseling is required to be considered for a liver transplant, or the candidate must meet specific requirements. In contrast to ALD, the pre-liver transplant requirements for patients with MASLD, such as weight loss goals or control of metabolic diseases, are not as well defined. Reviews and consensus statements on MASLD and liver transplantation discuss risk stratification and management for conditions associated with MASLD, but there are no consensus recommendations regarding obesity and metabolic disease goals pre- and post-transplant. Liver transplant candidates and recipients may be held to more stringent requirements and monitoring for alcohol use compared to weight loss goals and metabolic parameters advised for patients with MASLD. Because of the disparities in requirements between ALD and MASLD, consensus recommendations should be developed for pre- and post-liver transplant monitoring and requirements for candidates and recipients with MASLD.
