Background: This study aimed to systematically review and pool data regarding the alterations in the clinical course of inflammatory bowel disease (IBD) following liver transplantation (LT). Methods: Relevant prospective and retrospective observational studies were identified by searching databases and gray literature through December 2020. Random-effects models were used to calculate the pooled frequency of IBD patients with disease course alterations ("improved", "unchanged", or "aggravated") after LT and the corresponding 95% confidence intervals (CI). Results: Twenty-five studies met our inclusion criteria, reporting the outcomes in two or three categories. In the analysis of studies with three-category outcomes (n=13), the pooled frequencies of patients with improved, unchanged, or aggravated IBD course after LT were 29.4% (95%CI: 16.9%-41.9%), 51.4% (95%CI: 45.5%-57.3%), and 25.2% (95%CI: 15.6%-34.8%), respectively. Subgroup analyses revealed that patients with ulcerative colitis (UC), younger age at LT, or shorter duration of follow-up were more likely to have an improved disease course. Moreover, higher IBD exacerbation estimates were observed in studies with a low risk of bias. In the analysis of studies with two-category outcomes (n=12), the pooled frequencies of patients with improved/unchanged or aggravated IBD course were 73.6% (95%CI: 62.2%-85.0%) and 24.1% (95%CI: 15.1%-33.2%), respectively. The cumulative incidence of an exacerbated IBD course following LT was 0.22 (95% CI: 0.16-0.29, P < 0.001). Conclusion: We conclude that IBD activity remains unchanged (or improved/unchanged) in most IBD patients following LT. Furthermore, IBD type, age, and follow-up length can influence the IBD course after LT.