Metabolic syndrome after liver transplantation: A silent threat to long-term success

Liver transplantation (LT) has significantly improved survival for patients with end-stage liver disease, but post-transplant metabolic syndrome (MetS) has emerged as a major challenge, affecting graft function and long-term outcomes. Characterized by obesity, dyslipidemia, hypertension, and insulin resistance, MetS increases the risk of cardiovascular disease, recurrent liver disease, and reduced graft survival. We systematically examine current literature on the diagnosis, risk stratification, and management of MetS in LT recipients, with a focus on lifestyle interventions, pharmacologic strategies, and potential modifications in immunosuppressive regimens. Additionally, we discuss the role of emerging therapies, including GLP-1 receptor agonists, PCSK-9 inhibitors, and bariatric interventions, in mitigating metabolic risk in this population. With cardiovascular complications being the leading cause of post-LT mortality, proactive management of MetS is crucial. A multidisciplinary approach integrating hepatology, endocrinology, and cardiology is essential to optimize patient outcomes. Future research should focus on personalized metabolic interventions and long-term strategies to enhance post-transplant survival and quality of life.