LAUSR

BACKGROUND The true incidence and unique risk factors for recurrent and de novo nonalcoholic fatty liver (NAFLD) and nonalcoholic steatohepatitis (NASH) post liver transplant (LT) remain poorly characterized. We aimed to identify the incidence and risk factors for recurrent and de novo NAFLD/NASH post-LT. METHODS MEDLINE via PubMed, Embase, Scopus and CINAHL were searched for studies from 2000- 2018. Risk of bias was adjudicated using the Newcastle-Ottawa Scale. RESULTS Seventeen studies representing 2,378 patients were included. All were retrospective analyses of patients with post-LT liver biopsies, with the exception of two studies that used imaging for outcome assessment. Seven studies evaluated recurrent, three de novo, and seven included both. In studies at generally high or moderate risk of bias, mean 1, 3 and ≥5-year incidence rates may be: 59%, 57 %, and 82% for recurrent NAFLD; 67%, 40%, and 78% for de novo NAFLD; Mean 1, 3 and ≥5-year incidence rates may be: 53%, 57.4%, and 38% for recurrent NASH; 13%, 16%, and 17% for de novo NASH. Multivariate analysis demonstrated that post-LT BMI (summarized OR 1.27) and hyperlipidemia were the most consistent predictors of outcomes. CONCLUSIONS There is low confidence in the incidence of recurrent and de novo NAFLD and NASH after LT due to study heterogeneity. Recurrent and de novo NAFLD may occur in over half of recipients as soon as 1 year after LT. NASH recurs in most patients after LT, while de novo NASH occurs rarely. NAFLD/NASH after LT are associated with metabolic risk factors.