Can MASLD happen after a liver transplant?

Yes, MASLD can develop after a liver transplant.

If you had a transplant due to MASLD, there’s a high chance it will return in your new liver. This is called recurrent MASLD. Research suggests that around 40% of people develop a fatty liver following a liver transplant for MASLD.

MASLD can also develop in people who had a transplant for another liver disease. When this happens, it is called de novo MASLD (meaning “new” MASLD). De novo MASLD is not as common as recurrent MASLD.

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What increases the risk?

The factors that increase the risk of MASLD after a transplant are similar to those that cause it in the first place. These include:

• type 2 diabetes or pre-diabetes
• high blood pressure (hypertension)
• high cholesterol or fats in the bloodstream (hyperlipidaemia)

Other risk factors are:

• overweight, obesity or weight gain after your transplant
• fat in the donor liver (donor graft steatosis)
• use of immunosuppressive medications – some of the medicines used after transplant can increase the risk of liver fat

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What can you do to reduce the risk?

After a liver transplant, it’s very important to:

• eat a healthy, well-balanced diet
• stay physically active
• keep a healthy weight
• manage conditions such as type 2 diabetes, high blood pressure and high cholesterol
• take your prescribed medicines as directed

Your medical team will help you manage your medicines and health. A registered NHS dietitian can give you personalised advice on healthy eating. A physiotherapist can give advice on physical activity and exercise.

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How is MASLD treated after a transplant?

If MASLD develops in your new liver, treatment may include:

• Changes to your everyday life (diet, weight management, physical activity)
• Medicines for related conditions like diabetes or high cholesterol
• In some cases, weight-loss surgery

Finding MASLD early and having regular follow-up appointments are key to protecting your new liver.

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