Prognosis and Life Expectancy of NASH

Nonalcoholic steatohepatitis (NASH) is a form of liver disease that falls under the umbrella of nonalcoholic fatty liver disease (NAFLD). NAFLD occurs when fat builds up in the liver. NASH is an advanced form of NAFLD. It is when fat accumulation has led to inflammation and damage to the liver.¹

Not everyone with NAFLD will develop NASH. Understanding the stages can help people make informed decisions about treatment and lifestyle changes.^1,2

What is the NASH life expectancy?

NASH progresses slowly over many years. It can be hard to predict how NASH will progress because each case differs depending on the person. The prognosis and life expectancy of NASH largely depend on the stage of the disease. A liver biopsy can help pinpoint what stage of NASH a person is living with.^1,2

Early stages

In the early stages of NAFLD, the liver only has excess fat without inflammation or significant scarring. At this point, the prognosis is generally good. With healthy lifestyle changes, many people can prevent NAFLD from progressing to NASH. These changes include:^1,2

• Eating a healthy diet
• Getting regular exercise
• Managing underlying conditions like obesity and type 2 diabetes

The liver is a very regenerative organ (meaning it can heal itself). And it is even possible to reverse the existing liver damage. With proper management and lifestyle changes, many people with early-stage NASH will live a normal lifespan.^1,2

Advanced stages

As NAFLD progresses to NASH, inflammation and scarring occur, leading to fibrosis and cirrhosis. These conditions greatly impact life expectancy. Life expectancy will decline if fibrosis is severe enough. If cirrhosis due to NASH is diagnosed early, average life expectancy is predicted to be about 10 to 15 years. If symptoms of liver failure (also called “decompensated cirrhosis”) develop, such as confusion, bleeding in the GI tract, or holding on to excess fluid in the legs or stomach, the life expectancy can decline to 3 to 5 years or even less.^1,2

It is still possible to slow down the progression of the disease with lifestyle changes and medicines. But advanced fibrosis (stage 3) and cirrhosis (stage 4) increase the risk of complications such as liver failure and liver cancer.^1,2

For people with advanced NASH-related cirrhosis or liver failure, a liver transplant may be necessary. A liver transplant can be life-saving, but there are risks involved with this type of surgery.^3,4

How liver transplant need is determined

A liver transplant can be life-saving for those with end-stage liver disease. But not everyone with NASH will require a liver transplant. For example, people in the earlier stages of the disease generally do not need a transplant. A liver transplant is typically reserved for those with severe liver damage or complications.⁴

Determining whether a person with NASH needs a liver transplant involves a comprehensive evaluation by a healthcare team specializing in liver diseases. This team includes hepatologists (liver specialists), transplant surgeons, and transplant coordinators. Here is how they might assess whether a liver transplant is necessary:³

• Clinical assessment – This includes giving you a physical exam, going over your symptoms, and taking a complete medical history.
• Lab tests – Common tests include liver function tests, blood tests, imaging, and elastography. Elastography is an imaging test that determines the liver’s stiffness. Stiffness is an indicator of fibrosis.
• Liver biopsy – In a biopsy, a sample of the liver is taken and examined under a microscope to assess the extent of liver damage.

From there, your team will give you a model for end-stage liver disease (MELD) score. Your doctor will assess whether any complications might make a transplant difficult. They will also discuss with the transplant team the next steps, whether you are a candidate for liver transplant, and whether it is the best treatment option for you.³

Life expectancy after a liver transplant

According to a 2022 study, the life expectancy for people with NASH who received a liver transplant varied depending on:⁴

• Age
• Overall health
• Health status at the time of transplant
• Health status after the transplant

While it can be hard to estimate life expectancy after transplant, most patients go on to live 5 to 10 years or more following the procedure.⁵

There is hope

NASH is a serious condition, especially as it progresses to advanced stages. But there is hope.¹

By adopting a healthy lifestyle, managing comorbidities like obesity and type 2 diabetes, and working closely with their healthcare team, people with NASH can potentially slow down or even stop the progression of the disease. Early detection and proactive management are key to managing NASH effectively and improving long-term outcomes.¹