Waiting list mortality and 5-year transplant survival benefit of patients with MASLD: An Italian liver transplant registry study
Alessandro Vitale, Silvia Trapani, Francesco Paolo Russo, Luca Miele, Gianluca Svegliati‐Baroni, Giulio Marchesini, Patrizia Burra, Marco Salvatore Ottoveggio, Renato Romagnoli, Silvia Martini, Paolo De Simone, Paola Carrai, Matteo Cescon, Maria Cristina Morelli, Luciano De Carlis, L Belli, Salvatore Gruttadauria, Riccardo Volpes, M. Colledan, S. Fagiuoli, Fabrizio Di Benedetto, Nicola De Maria, G. Rossi, L. Caccamo, Francesca Donato, Giovanni Vennarecci, G.G. Di Costanzo, Marco Vivarelli, Amedeo Carraro, David Sacerdoti, Giuseppe Maria Ettorre, Valerio Giannelli, S. Agnes, Antonio Gasbarrini, Massimo Rossi, Stefano Ginanni Corradini, Vincenzo Mazzaferro, Sherrie Bhoori, Tommaso Maria Manzia, Ilaria Lenci, Fausto Zamboni, Laura Mameli, Umberto Baccarani, Pierluigi Toniutto, L. Lupo, Francesco Tandoi, Maria Rendina, Enzo Andorno, Edoardo G. Giannini, Marco Spada, Ilaria Billato, A. Marchini, Pierluigi Romano, Giuseppina Brancaccio, F. D’Amico, A. Ricci, Massimo Cardillo, Umberto Cillo
Abstract
Background & Aims: International consensus has recently introduced a new definition of metabolic dysfunction-associated steatotic liver disease (MASLD). We sought to analyse epidemiological trends, prognostic features, and transplant survival benefits of patients with MASLD and without MASLD waiting for liver transplantation (LT) in Italy. Methods: Using the Italian Liver Transplant Registry database, we analysed data from adult patients listed for primary LT attributable to end-stage chronic liver disease between January 2012 and December 2022. Independent multivariable waiting lists and post-transplant survival models were developed for patients with and without hepatocellular carcinoma (HCC). A Monte Carlo simulation was used to create 5-year transplant benefit distributions based on the presence of MASLD, HCC, and model for end-stage liver disease (MELD)-sodium values. Results: <0.001). At the same MELD-sodium, the 5-year transplant benefit was higher in patients with non-HCC MASLD, followed by patients with HCC, whereas it was lower in patients without HCC and without MASLD. Conclusions: Patients with non-HCC MASLD had an increased waitlist mortality and 5-year transplant survival benefit compared with other candidates. Impact and implications: The present research addresses the critical need to understand the evolving landscape of liver transplantation indications, mainly focusing on metabolic dysfunction-associated steatotic liver disease (MASLD) in Italy. Given the significant rise in MASLD cases, these findings highlight that patients with non-HCC MASLD face increased waitlist mortality and benefit more from liver transplantation within 5 years compared with other candidates. The significance of these results lies in their emphasis on the necessity of focusing on patients with MASLD on waiting lists to improve outcomes. By tailoring transplant eligibility criteria and resource allocation, the study provides actionable insights to improve patient survival and optimise liver transplantation practices.