Liver transplantation in the era of obesity: A metabolic public health crisis meets a surgical frontier
Sofia Rozani, Μaria Dalamaga, Georg Weber, Robert Grützmann
Abstract
The global obesity epidemic has reshaped the landscape of liver transplantation (LT). Metabolic dysfunction-associated steatotic liver disease (MASLD) has become one of the leading indications for LT in Western countries, while excess adiposity simultaneously complicates donor and recipient selection, surgical outcomes, and long-term graft survival. Although previous studies have examined obesity, MASLD, and LT separately, an integrative overview of their bidirectional relationship and its clinical implications is lacking. This mini-review addresses that gap by synthesizing current evidence on how obesity influences LT candidacy, perioperative risk, graft outcomes, and metabolic complications after transplantation. We further highlight emerging concepts of "metabolic fitness," the role of prehabilitation, novel pharmacotherapies, and bariatric interventions, while underscoring the urgent need for transplant-specific metabolic guidelines. Without upstream prevention and coordinated system-level adaptation, transplant programs will face an unsustainable burden of obesity-related liver disease.