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Aim: To investigate the efficacy and safety of glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) and sodium‐glucose cotransporter‐2 (SGLT2) inhibitors in liver transplant (LT) recipients with diabetes. Methods: A single‐centre, retrospective analysis of prospectively collected data from an LT recipient database (1990–2023) was conducted. We included adults with pre‐existing diabetes and post‐transplant diabetes, newly started on GLP‐1RAs and/or SGLT2 inhibitors after LT. Metabolic and biochemical parameters and outcomes were collected for up to 12 months after starting medications and were compared to those in patients receiving dipeptidyl peptidase‐4 (DPP‐4) inhibitors. Statistical analysis included descriptive statistics and linear mixed models. Results: We included participants on GLP‐1RAs (n = 46), SGLT2 inhibitors (n = 87), combination therapy (n = 12), and a DPP‐4 inhibitor comparator (n = 217). Both GLP‐1RAs and combination therapy decreased mean glycated haemoglobin (HbA1c) levels, and combination therapy remained significant when adjusted for DPP‐4 inhibitor treatment (−3.5%, 95% CI [−6.1, −0.95]; p = 0.0089) at 12 months. All three groups had significant decreases in mean weight and body mass index, but these remained significant in the GLP‐1RA (−5.2 kg, 95% CI [−8.7, −1.7], p = 0.0039 and 1.99 kg/m2, 95% CI [−3.4, −0.6], p = 0.0048) and combination therapy groups (−5.4 kg, 95% CI [−10.5, −0.36], p = 0.04 and −3.4 kg/m2, 95% CI [−5.5, −1.3], p = 0.0015) when adjusted for DPP‐4 inhibitor treatment at 12 months. Alanine aminotransferase levels decreased with GLP‐1RA and combination therapy. There were two (1.4%) cases of graft rejection. Conclusion: We found that GLP‐1RAs, SGLT2 inhibitors, and their combination, led to significant weight loss in LT recipients with diabetes. Combination therapy, in particular, lowered HbA1c and alanine aminotransferase levels compared to DPP‐4 inhibitors. Further studies are needed to assess long‐term safety and efficacy. [ABSTRACT FROM AUTHOR]

The increasing prevalence of steatotic liver disease (SLD) in potential living donors is concerning, as it limits donor's availability amid rising demand. OPTIFAST very low-calorie diet (VLCD), a meal replacement product, effectively reduces weight and hepatic steatosis before transplantation. However, data on the outcomes of recipients of VLCD-treated donors are lacking. We conducted a single-center, retrospective study on 199 living donor liver transplant recipients at Toronto General Hospital, Canada, between January 2015 and January 2020. We compared the 1-year posttransplant outcomes between recipients who received organs from donors treated with VLCD (N = 34) for either weight loss or steatosis reduction, with those who did not require treatment (N = 165). Our analysis revealed no statistically significant differences in the rates of postoperative complications (23% vs 32.4%, p = 0.3) or intensive care unit stays (70.9% vs 70.6%, p = 1) between recipients of non-VLCD and VLCD grafts. Following adjusted multivariate logistic regression, receipt of VLCD grafts was not associated with increased hospital length of stay. In addition, one-year mortality did not differ between the two groups (4.2% non-VLCD recipients vs 2.9% VLCD recipients, p = 0.6). OPTIFAST VLCD treatment for liver donors demonstrates positive and safe outcomes in recipients, expanding the pool of potential living donors for increased organ availability. [ABSTRACT FROM AUTHOR]

Summary: Background: Lifestyle interventions are the primary treatment for metabolic (dysfunction) associated fatty liver disease (MAFLD). However, the histological and cardiometabolic effects of aerobic exercise in MAFLD remain unclear. Aims: To assess the effects of a 12‐week aerobic exercise intervention on histological and cardiometabolic endpoints in MAFLD. Methods: Patients with biopsy‐confirmed MAFLD participated in a 12‐week aerobic exercise intervention. Liver histology, cardiorespiratory fitness (estimated V̇O2max), physical activity, anthropometry and biochemical markers were assessed at baseline, intervention completion, and 12 and 52 weeks after intervention completion. Results: Twenty‐four patients completed the exercise intervention (exercise group n = 16, control group n = 8). In the exercise group, 12 weeks of aerobic exercise reduced fibrosis and hepatocyte ballooning by one stage in 58% (P = 0.034) and 67% (P = 0.020) of patients, with no changes in steatosis (P = 1.000), lobular inflammation (P = 0.739) or NAFLD activity score (P = 0.172). Estimated V̇O2max increased by 17% compared to the control group (P = 0.027) but this level of improvement was not maintained at 12 or 52 weeks after the intervention. Patients with fibrosis and ballooning improvement increased estimated V̇O2max by 25% (P = 0.020) and 26% (P = 0.010), respectively. Anthropometric reductions including body mass (P = 0.038), waist circumference (P = 0.015) and fat mass (P = 0.007) were also observed, but no patient achieved 7%‐10% weight loss. Conclusion: This study highlights the potential benefits of a 12‐week aerobic exercise intervention in improving histological endpoints of MAFLD. The development of strategies to ensure continued engagement in aerobic exercise in MAFLD are needed. [ABSTRACT FROM AUTHOR]