Post-transplant MASLD: a risk-stratified approach to assessment and personalized management.

Metabolic dysfunction-associated steatotic liver disease (MASLD) has become a major indication for liver transplantation (LT) and is expected to account for an increasing proportion of transplant candidates worldwide. As long-term post-transplant survival continues to improve, post-LT MASLD has increasingly emerged as a major metabolic complication affecting long-term prognosis. Unlike MASLD in the non-transplant setting, post-LT MASLD is strongly influenced by transplant-specific factors, including recipient metabolic dysfunction, immunosuppressant use, graft-related characteristics, and metabolic alterations following transplantation, resulting in substantial heterogeneity in clinical presentation and disease progression. Current evidence suggests that recipient-related metabolic factors, particularly obesity, type 2 diabetes, dyslipidemia, hypertension and post-transplant weight gain, play central roles in the pathogenesis, whereas donor-related characteristics may contribute predominantly to early liver fat accumulation. Importantly, the clinical significance of post-LT MASLD extends beyond simple steatosis and is closely associated with fibrosis progression, cardiovascular events, renal dysfunction, and other systemic metabolic complications. Nevertheless, the current literature remains highly heterogeneous. This variability likely reflects evolving disease definitions, the frequent failure to distinguish recurrent from