Abstract
INTRODUCTION: We describe the epidemiology of metabolic dysfunction-associated steatotic liver disease (MASLD) and evidence of advanced liver fibrosis by readily available noninvasive diagnostics and their implications to kidney transplant recipients (KTRs). METHODS: In this retrospective cohort study of first-time KTRs (2008-2020), we assessed the prevalence and incidence of MASLD (hepatic steatosis on abdominal ultrasound alongside ≥ 1 cardiometabolic risk factors) and advanced hepatic fibrosis (Fibrosis-4 (FIB-4) index > 2.67). We fitted multivariable time-dependent Cox regression models to assess associations between MASLD and a composite of graft dysfunction (estimated glomerular filtration rate [eGFR] < 30 mL/min per 1.73 m(2)), death-censored graft failure (DCGF), death with graft function (DWGF), and each distinct end point. RESULTS: In 650 eligible KTRs (median age 57.2 [interquartile range {IQR}: 45.0-66.0] years, 34% female), prevalence per 100 KTR (95% confidence interval [CI]) at transplantation and 5-years post-transplant, was 21.7 (18.6-25.1) and 42.3 (38.5-46.2), respectively, for MASLD and 42.9 (39.1-46.8) and 69.7 (66.0-73.2), respectively, for advanced fibrosis. Incidence rate per 100 person-years was 5.5 (4.7-6.4) for MASLD and 2.2 (1.6-2.9) for advanced fibrosis in KTRs without MASLD and advanced fibrosis at transplantation, respectively. Adjusted hazard ratios (HR) for the composite, graft dysfunction, DCGF, and DWGF were 1.27 (0.98-1.65), 1.24 (0.86-1.78), 1.14 (0.75-1.73), and 1.56 (1.04-2.33) with versus without MASLD and 1.76 (1.14-2.71), 1.47 (0.71-3.01), 3.28 (1.78-6.06), and 1.68 (0.91-3.13) with FIB-4 > 2.67 versus FIB-4 < 1.3, respectively. CONCLUSION: KTRs with MASLD and advanced hepatic fibrosis demonstrate lower patient and graft survival, which could be amenable to timely interventions for cardiometabolic risk reduction.