S2850 Complications of Portal Hypertension in Patients With Cirrhosis Due to MetALD, MASLD, and ALD

Introduction: Complications of portal hypertension (pHTN) can vary by cause of liver disease. There are limited data regarding complications of pHTN in patients with cirrhosis due to MetALD. The aim of this study was to compare complications of pHTN among patients with cirrhosis due to MetALD, MASLD, and ALD. Methods: This retrospective cohort study evaluated liver transplant candidates at a single center who underwent transplantation between 1/2012 and 1/2022 with cirrhosis classified as MetALD, MASLD, or ALD according to recent criteria (Rinella ME et al., 2023). Differences between groups were assessed via Fisher’s exact test or Monte Carlo simulated Fisher’s exact test for categorical variables, one-way ANOVA for normally distributed continuous variables, Kruskal-Wallis test for non-normally distributed continuous variables, and Fisher’s exact test for pairwise comparisons. Results: Two hundred ninety-five patients were included: MetALD (n = 113), MASLD (n = 121), and ALD (n = 61). Age at transplant differed significantly, with MASLD patients being oldest, followed by MetALD, and ALD patients. Female sex was most prevalent in the MASLD group compared to MetALD, and ALD. In pairwise comparisons, the ALD group had higher rates of variceal bleeding and hepatic encephalopathy (both P < 0.05) and a similar rate of ascites relative to the MetALD group. The MASLD group had a higher frequency of variceal bleeding (P < 0.05) and similar rates of hepatic encephalopathy and ascites relative to the MetALD group. Conclusion: Complications of pHTN varied by cause of liver disease. Patients with MetALD cirrhosis had lower rates of variceal bleeding and hepatic encephalopathy than those with ALD cirrhosis and a lower rate of variceal bleeding than patients with MASLD cirrhosis.