Non-alcoholic fatty liver disease (NAFLD) is a complex, multifactorial, multistage disease that has become the greatest cause of liver disease and liver failure in the United States. However, there is a substantial interpatient variation in progression and outcome. The risk for disease development and disease progression are determined by a combination of environment factors and multiple genetic factors. Much progress has been made to determine genetic factors predisposing to NAFLD by the examination of candidate gene studies as well as genome-wide approaches. Variants such as PNPLA3 have been previously identified as important risk factor for both NAFLD and progression of NALFD to steatohepatitis. The liver transplant population encompasses the most severe progression of the disease and are therefore important to understanding its pathogenesis.
The prevalence of NAFLD in organ donors is also increasing rapidly. There is a growing need to understand which donor livers with NAFLD will tolerate the transplant process and provide long-term benefit in the transplant recipient.