Published online Dec 28, 2013. doi: 10.3748/wjg.v19.i48.9146
Revised: October 28, 2013
Accepted: November 1, 2013
Published online: December 28, 2013
Processing time: 105 Days and 6.7 Hours
Core tip: Non-alcoholic fatty liver disease (NAFLD) is a prevalent indication for liver transplantation. It also poses a risk to organ donation, with decreasing rates of suitable allografts. NAFLD frequently recurs in the allograft or develops de novo. Post-transplant recurrence is related to obesity and immunosuppression associated metabolic derangements. A polymorphism in PNPLA3 also increases recurrence risk. Pre-transplant data favors sustained weight loss through diet and exercise as the most effective therapy for NAFLD. Vitamin E and insulin-sensitizing agents are occasionally used. Trials on immune-suppression regimens in this population are sorely needed. A multimodality approach to treatment should be utilized in management of post-transplant NAFLD.