*Purpose: Nonalcoholic fatty liver disease (NAFLD) has emerged as the most common chronic liver disease worldwide. Cirrhosis secondary to Nonalcoholic Steatohepatitis (NASH) is projected to become the leading indication for liver transplantation (LT) worldwide. Characteristics and outcome of patients transplanted for NASH cirrhosis have not been previously reported from our region. Our aim was to evaluate the prevalence of metabolic syndrome and long term outcome of patients transplanted for NASH related cirrhosis.

*Methods: All patients transplanted for NASH related cirrhosis at our institution from 2001-2016 were included in this study. Clinical, laboratory and survival outcomes were collected from our prospectively collected database.

*Results: 108 (77 males and 31 females) patients were transplanted for NASH related cirrhosis at our institution. Sixteen (15%) patients had pretransplant hepatocellular carcinoma. Pretransplant obesity (BMI>30), diabetes, hyperlipidemia and hypertension were present in 43 (40%), 57 (53%), 20 (19%), and 30 (28%) patients, respectively. Following LT patients were followed for an average of 103 months (range 54-203 months). Post-transplant diabetes, hyperlipidemia and hypertension were present in 62 (57%), 25 (23%) and 48 (44%) patients, respectively. 48 (44%) patients developed renal impairment (GFR <60) during follow up period. Fifty (46%) patients developed disease recurrence with significant fatty infiltration on various imaging modalities. Diabetes, hyperlipidemia and hypertension in patients with post-transplant disease recurrence were 30 (77%), 16 (41%) and 24 (62%), respectively. Sixteen patients were treated for mild rejection and only one patient developed ductopenic rejection resulting in graft loss. Sixteen (15%) patients developed severe cardiovascular complications. Overall survival during the follow period was 83%. One and three year survivals were 92.5% and 87% respectively. Sepsis was the commonest cause of death in our patient population. Two patients died of liver cirrhosis secondary to post transplant HBV infection and ductopenic rejection. Three patients died secondary to acute cardiovascular events. One patient died secondary to complications related to graft versus host disease.

*Conclusions: Disease recurrence in our patient population was common; however, post-transplant cirrhosis remains rare. The prevalent metabolic syndrome negatively impacted renal function and resulted in cardiovascular complications.

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