*Purpose: Despite the increasing incidence of non-alcoholic steatohepatitis (NASH) worldwide, its impact on mortality or major adverse cardiovascular events (MACE) in non-liver solid organ transplant recipients (NL-SOT) is unknown.

*Methods: Using a retrospective design, adult NL-SOT recipients who had biopsy-proven NASH were compared to NL-SOT recipients with normal liver function tests and normal liver abdominal imaging. Both deceased and living donor recipients were included; heart and liver transplant patients were excluded. Primary outcome was incidence of all-cause mortality and MACE (a composite outcome of coronary artery disease, ischemic stroke, and peripheral arterial disease).

*Results: 7 patients (3 kidney and 4 lung transplant) had biopsy-proven NASH and 6356 patients without NASH, both groups were predominantly male (58%), white (86%), and overweight (mean BMI 26.6). The majority of patients were on calcineurin inhibitors (> 85%), antimetabolites (> 90%), and prednisone (>50%). 6 (85.7%) NASH patients died over the follow-up period: causes of death included infection (3 patients) and cardio-vascular disease (1 patient). In an adjusted survival analysis (Figure 1 and Table 1), NASH patients had a higher risk of death, HR 2.56 (95% CI 1.14, 5.75), p= 0.02. NASH did not affect the risk of death-censored graft failure (HR 0.65 (95% CI 0.09, 4.61)) or the risk of MACE (HR 0.85 (95% CI 0.21, 3.41)).

*Conclusions: In NL-SOT recipients, NASH is significantly associated with mortality but not MACEs. Given the known metabolic complications of immunosuppression, NASH in NL-SOT recipients is likely an underrepresented problem. Larger retrospective and prospective studies should be undertaken to further study this concerning association.

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