Table 11.

Screening and management for comorbidities in individuals with MASLD before liver transplantation. Modified from [496, 497]

Condition	Recommendation
Type 2 diabetes	• Screen for impaired fasting glucose (IFG) or glucose tolerance (IGT) and/or T2D (OGTT, HbA1c) • Achieve glycaemic control before LT • Preferentially use weight-lowering (e.g. SGLT2 inhibitors, GLP1RA) or weight-neutral (e.g. metformin) diabetes medication, considering risk of other diabetes complications, if liver and/or renal function allow this
Nutrition	• Assess nutritional status before LT • Assess alcohol consumption • Healthy diet, physical exercise and lifestyle modification (including weight reduction in individuals with obesity) represent pillars in pre-LT management
Cardiovascular	• Pre-LT cardiovascular risk stratification is mandatory • Risk-adapted algorithm of cardiac work-up should be followed (see Fig. 5) • LT candidates with cardiovascular risk should be managed with goal-directed medical management (e.g., statins, anti-platelet agents, beta blockers, RAAS blockers), based on the stage of cirrhosis and renal function
Kidney	• Kidney function should be adequately monitored before LT • Comedications need to be adjusted (or replaced) dependent on kidney function
Malignancies	• Screening for pre-LT malignancies should follow the same protocols applied to individuals with non-MASLD related cirrhosis (including gastrointestinal and genital cancers)

GLP1RA, glucagon-like peptide-1 receptor agonist; HbA1c, glycated haemoglobin; LT, liver transplantation; MASLD, metabolic dysfunction-associated steatotic liver disease; OGTT, oral glucose tolerance test; RAAS, renin-angiotensin-aldosterone system; SGLT2, sodium-glucose cotransporter-2.