Aim: The Aim of this study is to Long term follow up of liver related death rates in patient with Non-Alcoholic and Alcoholic related fatty Liver Disease. Methods: For this study we have chosen the patient who underwent a liver biopsy from last twenty years. Only patients with NAFLD and AFLD were included and medical records reviewed. The patients were linked to the Hospital Discharge Register, the Causes of Death Registry and Centre for Addiction Medicine. Results: Overall , 2432 liver biopsies were performed during the study period. A total of 450 patients with at least one index biopsy were identified by the computerized search in the pathology database as having fatty liver on biopsy. Those who were misclassified and did not have fatty liver on review were excluded (Figure 1). A total of 180 patients were excluded for other reasons than based on histopathology (Figure 1). The remaining study group of 270 patients had no signs of viral hepatitis in the index liver biopsy and did not receive any medication known to be associated with the development of steatosis.Medical records from these patients were traced and the biopsies reviewed by experienced pathologists. A total of 270 patients constituted the study group, 145 (60%) women and 125 men (40%). Women were in the majority in the NAFLD group, 100/150 (70%) compared to 50/150 (30%) men (p < 0.001). The proportion of men was higher in the AFLD group, that is 67% (63/94) whereas the proportion of women was 30/90(30%). Conclusions: Patients with fatty liver disease showed a markedly higher risk of developing liver-related death compared to the general population. The AFLD group had higher liver-related mortality and had a worse survival than the NAFLD group. Patients with more severe fibrosis at baseline showed a worse survival than patients with none or mild fibrosis at baseline.