Semaglutide-inclusive multimodal therapy reverses ultra-rapid MASH recurrence post-liver transplant in obese patient

Recurrence of Metabolic dysfunction-associated steatohepatitis (MASH) after liver transplantation is a significant concern, typically occurring months to years post-surgery in 11-24% of recipients. However, early recurrence, defined as within six months, is exceedingly rare and poorly understood, presenting a critical clinical challenge. Obesity is a primary driver of MASH progression and recurrence, exacerbating metabolic dysregulation. Current standard-of-care often struggles with such aggressive, early-onset disease, necessitating novel therapeutic approaches to prevent rapid graft deterioration and improve long-term outcomes.

This case report details a 40-year-old woman with obesity and a history of remote kidney transplant who underwent liver transplantation for MASH cirrhosis. At 10 weeks post-transplant (approximately 70 days), she presented with acute cellular rejection and significant steatosis. Following initial corticosteroid treatment, her condition rapidly worsened. A multimodal intervention was initiated, which notably included semaglutide (dose and route not specified in abstract). The primary endpoint was histological assessment of liver biopsy and biochemical normalization.

The patient experienced an ultra-rapid recurrence of MASH, initially presenting with 68% steatosis at 10 weeks post-transplant. This rapidly progressed to >95% steatohepatitis with F1 fibrosis within just 6 days of corticosteroid treatment, highlighting the aggressive nature of the recurrence. Despite the rapid deterioration, the subsequent multimodal intervention, which incorporated semaglutide, yielded a favorable response. > Histological examination revealed a significant reduction in steatosis to 30%, with complete resolution of ballooning degeneration. This was accompanied by sustained biochemical normalization, indicating a robust therapeutic effect on liver health.