The rising tide of non-alcoholic fatty liver disease (NAFLD) associated with the obesity epidemic is a major health concern worldwide. NAFLD — specifically its more advanced form, non-alcoholic steatohepatitis (NASH)-related cirrhosis — is now the fastest growing indication for liver transplantation in the USA and Europe. Although the short-term and mid-term overall survival rates of patients who receive a liver transplant for NASH-related cirrhosis are essentially similar to those of patients who receive a transplant for other liver indications, recipients with NASH-related cirrhosis have an increased risk of waiting-list mortality and of developing recurrent liver disease and cardiometabolic complications in the longer term after liver transplantation. This Review provides a brief overview of the epidemiology of NAFLD and NASH and the occurrence of NAFLD or NASH in patients after liver transplantation for NASH and other liver indications. It also discusses the putative metabolic mechanisms underlying the emergence of NAFLD or NASH after liver transplantation as well as optimal therapeutic approaches for recipients of liver transplants, including the management of cardiometabolic comorbidities, tailored immunosuppression, lifestyle changes and pharmacotherapy for NAFLD.

与肥胖流行相关的非酒精性脂肪肝病 (NAFLD) 的上升趋势是全球主要的健康问题。NAFLD - 特别是其更高级的形式，非酒精性脂肪性肝炎 (NASH) 相关肝硬化 - 现在是美国和欧洲肝移植增长最快的适应症。尽管因 NASH 相关肝硬化接受肝移植的患者的短期和中期总生存率与因其他肝脏适应症接受肝移植的患者基本相似，但 NASH 相关肝硬化的受者风险增加等待名单上的死亡率以及肝移植后长期发展为复发性肝病和心脏代谢并发症。本综述简要概述了 NAFLD 和 NASH 的流行病学以及 NASH 和其他肝脏适应症肝移植后患者发生 NAFLD 或 NASH 的情况。它还讨论了肝移植后出现 NAFLD 或 NASH 的假定代谢机制，以及肝移植受者的最佳治疗方法，包括心脏代谢合并症的管理、量身定制的免疫抑制、生活方式的改变和 NAFLD 的药物治疗。