infohep is no longer being updated. Visit for HIV and hepatitis news.

NASH is fastest-growing reason for a liver transplant in United States

Keith Alcorn
22 June 2020

Non-alcoholic steatohepatitis (NASH), the severe form of non-alcoholic fatty liver disease (NAFLD), is now the most common reason for a liver transplant in women, older patients and people receiving Medicare insurance in the United States, a review of liver transplants in 2019 has found.

The findings are published in Clinical Gastroenterology and Hepatology and update findings presented by another research group at the 67th Meeting of the American Association for the Study of Liver Diseases in 2016.

NASH develops after chronic inflammation caused by fat accumulation in the liver damages liver cells and structure. Between 30 and 40% of adults in the United States have NAFLD and between 3 and 12% had NASH in studies published in 2011 and 2013 (Kim; Williams).


hepatocellular carcinoma (HCC)

Liver cancer. A long-term complication of chronic inflammation of the liver or cirrhosis.

The prevalence of NASH and NAFLD are growing in the United States due to obesity and prevalence of NASH is especially high among people with severe obesity (body mass index over 40).

Previous research by the same group found that NASH was the fastest-growing cause of hepatocellular carcinoma (HCC) in the United States between 2002 and 2016.

Researchers compared liver transplant waiting lists between 2002 and 2019 using the Scientific Registry of Transplant Recipients. A total of 168,441 people with chronic liver disease were listed for a transplant between 2002 and 2019, including 16.5% with HCC.

In 2002 the most common reasons for being placed on the transplant waiting list were severe liver disease caused by hepatitis C (37%) or alcoholic liver disease (16%). NASH was the reason for a liver transplant in only 5% of cases. In patients with HCC, NASH was even less common; only 1% of people with HCC had NASH, whereas 58% had hepatitis C.

In 2019 hepatitis C remained the leading indication for liver transplant wait listing (40%) overall but in several sub-groups NASH had become the most common reason. NASH was the leading indication in women without HCC (34%), in patients older than 54 years (36%), and in patients on Medicare (41%). In trend analysis, NASH was the most rapidly increasing indication for liver transplantation in patients without HCC (Kendall tau=0.97; P<.001) and in patients with HCC (tau=0.94; P<.0001).


Younossi ZR, et al. Nonalcoholic Steatohepatitis is the most rapidly increasing indication for liver transplantation in the United States. Clinical Gastroenterology & Hepatology, advance online publication, 9 June 2020,

Kim D, et al. Association between non-invasive fibrosis markers and mortality among adults with non-alcoholic fatty liver disease in the United States. Hepatology. 57:1357-1365, 2013.

Williams CD, et al. Prevalence of nonalcoholic fatty liver disease and nonalcoholic steatohepatitis among a largely middle-aged population utilizing ultrasound and liver biopsy: a prospective study. Gastroenterology. 140:124- 131, 2011.