MASLD and Liver Transplantation: Clinical Challenges, Systemic Complications, and Emerging Role of GLP-1 Receptor Agonists

Metabolic dysfunction-associated steatotic liver disease (MASLD) is currently the most common chronic liver disease worldwide, affecting approximately 30% of the global population, with prevalence reaching up to 50% in certain regions. Its burden is expected to rise in the coming years, primarily due to its potential to progress to liver cirrhosis and ultimately lead to liver transplantation. MASLD has emerged as one of the leading indications for liver transplantation globally, placing its management at the forefront of liver transplant care. Encouraging results from ongoing clinical trials suggest the potential to mitigate the global impact of MASLD in the near future. Glucagon-like peptide-1 (GLP-1) receptor agonists have demonstrated promising efficacy in the management of MASLD and are likely to receive approval for its direct treatment. Their beneficial effects on adiposity, along with their ability to reduce cardiovascular and renal burden, further enhance their therapeutic value. Additionally, their potential application in liver transplant settings is gaining increasing attention. In this narrative review, we explore the rising impact of MASLD within transplant medicine, its interplay with metabolic comorbidities, and the emerging utility of GLP-1 receptor agonists in liver transplantation care.

Keywords: MASLD, MASH, cirrhosis, fibrosis, liver transplantation, GLP-1