Metabolic Steatohepatitis After Liver Transplantation

Metabolic liver disease has become a leading indication for liver transplantation in Western countries, making the management of metabolic dysfunction-associated steatotic liver disease (MASLD) in transplant recipients increasingly critical. Early detection of hepatic steatosis and fibrosis in grafts remains contentious, with non-invasive tools offering support but liver biopsy still regarded as the gold standard. Advances in the treatment of metabolic dysfunction-associated steatohepatitis (MASH), are expanding, with new therapeutic guidelines anticipated to streamline management. Post-transplant, the control of MASH and associated metabolic comorbidities requires a preventive approach focused on lifestyle and weight loss interventions. Pharmacological treatments have shown limited efficacy, emphasizing the importance of early intervention. Immunosuppressive regimens tailored to reduce metabolic complications demonstrate promise in mitigating risks without compromising immunological stability. As therapeutic innovations progress, they are expected to enable increasingly personalized approaches to metabolic complications in liver transplantation.