Optimal Management of Obesity in Transplant Candidates and Recipients

Obesity constitutes a global crisis with profound implications on the incidence of metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH). This paper aims to comprehensively explore the escalating obesity epidemic’s implications on liver transplantation, focusing on trends, clinical consequences, and therapeutic interventions to optimize outcomes for transplant candidates and recipients. Lifestyle modifications, including dietary and exercise programs, are crucial for pre- and post-transplant obesity managements. When lifestyle modifications prove insufficient, several FDA-approved pharmacologic options, such as orlistat, phentermine-topiramate, naltrexone-bupropion, liraglutide, semaglutide, and tirzepatide, can be considered. Bariatric surgical and endoscopic interventions are also viable options for select patients during all phases of liver transplantation with durable weight loss results. Individualized therapeutic interventions should be crafted based on a comprehensive assessment, considering nutritional status, physical health, and the severity of liver disease. While lifestyle modification and pharmacologic interventions should be the initial course of action, their efficacy may be suboptimal. In such cases, consideration of bariatric intervention becomes imperative.