NAFLD is increasingly recognized as the most common chronic liver disease in the western world. With the increasing prevalence of the risk factors of NAFLD (i.e. Obesity, DM), the magnitude of its impact on liver transplantation (LT) is yet to be fully determined. The aim is to investigate the LT trends of recipients with NASH. Methods: Using the UNOS database, we identified all adult (> 18 yrs) LT recipients with NASH (2007 – 2010). Data extracted included patient demographics, MELD score and UNOS Regions. Results: 1,252 candidates with NASH underwent LT, accounting for 7.7% of all adult LT. There were 52.4 % female with an ethnic distribution of White 79.5%, Hispanic 16.2%, Asian 1.76% and Black 1.1%. There was a significant increase in LT rate during the study period, especially in the over 65 yrs age group from 10 % to 13% compared to 35 – 49 years (2.5% to 4.8%) and 50 – 64 years (5.2% to 7.7%). Among the various ethnic groups, the proportion of Hispanic and White recipients with NASH was 11.8% and 11.4% respectively compared to Asian (4.6%) and Blacks (1.97%). There was also a wide regional variation in LT rate ranging from 4.4% (Region 9) to 13.4% (Region 3). Conclusion: There is steady increase in the proportion of LT for NASH in United States. The rise in the proportion of LT for NASH correlates with the increasing prevalence of the risk factors associated with NASH. In particular, the regional variation we observed correlates in part to the geographic areas (i.e. states/regions) with a high prevalence of obesity. This study highlights the impact of the rising prevalence of NASH on the demand for LT and provides invaluable information to healthcare policy makers and transplant community about the target group (age >65 years, Hispanic/White and Regions with High Obesity prevalence) for focused and early intervention.

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