Déjà vu! A Case of Recurrent Metabolic Dysfunction-Associated Steatohepatitis 70 Days After Liver Transplantation.

Metabolic dysfunction-associated steatohepatitis (MASH) recurrence following liver transplantation occurs in 11%-24% of recipients, typically months to years posttransplant. Early recurrence (<6 months) is extremely rare. We present a 40-year-old woman with obesity and remote kidney transplant who underwent liver transplantation for MASH cirrhosis. At 10 weeks posttransplant, she developed acute cellular rejection and 68% steatosis, progressing to >95% steatohepatitis with F1 fibrosis within 6 days on corticosteroid treatment. Multimodal intervention, including semaglutide, resulted in histologic improvement (steatosis reduced to 30%, ballooning resolved) with sustained biochemical normalization. This case highlights ultra-rapid MASH recurrence and favorable histological response to early multimodal metabolic intervention.