Outcomes of Nonalcoholic Steatohepatitis After Liver Transplantation: An Updated Meta-Analysis and Systematic Review

Jie Ning Yong, Wen Hui Lim, Cheng Han Ng, Darren Jun Hao Tan, Jieling Xiao, Phoebe Wen Lin Tay, Snow Yunni Lin, Nicholas Syn, Nicholas Chew, Benjamin Nah, Yock Young Dan, Daniel Q. Huang, Eunice Xiang Xuan Tan, Arun J. Sanyal, Mazen Noureddin, Mohammad Shadab Siddiqui, Mark D. Muthiah

Research output: Contribution to journalReview articlepeer-review

21 Scopus citations


Background & Aims: Nonalcoholic steatohepatitis (NASH) is the fastest growing indication of liver transplantation (LT) and is projected to be the leading cause of LT in the near future. The systemic pathogenesis of NASH increases risks of adverse clinical outcomes in patients with NASH receiving LT. Thus, this study aimed to conduct a time-dependent survival analysis between LT recipients with and without NASH using hazard ratios. Methods: A search was conducted on Medline and Embase databases for articles relating to LT outcomes for NASH recipients. A survival analysis was conducted of hazard ratios using the DerSimonian and Laird random-effects model with meta-regression. To account for censoring, survival data were reconstructed from published Kaplan–Meier curves and pooled to derive more accurate hazard estimates and all-cause mortality in NASH patients after LT. Pairwise meta-analysis was conducted to analyze secondary outcomes. Results: Fifteen studies involving 119,327 LT recipients were included in our analysis with a prevalence of NASH of 20.2% (95% CI, 12.9–30.2). The pooled 1-year, 5-year, and 10-year all-cause mortality in NASH patients after LT were 12.5%, 24.4%, and 37.9%, respectively. Overall survival was comparable between LT recipients for NASH vs non-NASH (hazard ratio, 0.910; 95% CI, 0.760 to 1.10; P = .34). Meta-regression showed that a higher model for end-stage liver disease score was associated with significantly worse overall survival in NASH compared with non-NASH after LT (95% CI, -0.0856 to -0.0181; P = .0026). Conclusions: This study shows that patients undergoing LT for NASH cirrhosis have comparable complication rates, overall survival, and graft survival compared with non-NASH patients, although close monitoring may be indicated for those with higher model for end-stage liver disease scores.

Original languageEnglish (US)
Pages (from-to)45-54.e6
JournalClinical Gastroenterology and Hepatology
Issue number1
StatePublished - Jan 2023


  • Liver Transplantation
  • Nonalcoholic Fatty Liver Disease
  • Nonalcoholic Steatohepatitis
  • Severity of Illness Index
  • Humans
  • Risk Factors
  • End Stage Liver Disease/complications
  • Treatment Outcome
  • Retrospective Studies
  • Liver Transplantation/adverse effects
  • Non-alcoholic Fatty Liver Disease/complications

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology


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