Table 1.

Management of patients with NAFLD before liver transplantation.

Condition	Recommendations
Diabetes mellitus	•OGTT is the gold standard for diagnosis of diabetes mellitus. •HbA1c if used should be associated to continuous blood glucose monitoring. •Adequate glycaemic control should be achieved. •Careful assessment of severity of liver disease is mandatory to identify the best therapeutic approach.
Nutritional status	•Assessment of nutritional status is mandatory before LT. •For obese patients, lifestyle modification represents the first-line intervention. •Healthy diet should be promoted according to indication shown in Figure 2. •Physical exercise should focus on preservation of residual motility. Caution should be taken in malnourished and sarcopenic patients to avoid increase of catabolism and muscle loss. •In obese patients not responding to diet and physical exercise pharmacological therapy or bariatric surgery can be carefully considered.
Cardiovascular disease	•Pre-LT cardiovascular risk stratification is mandatory. •Specific algorithm of cardiac work-up should be followed as shown in Fig. 1.
Kidney dysfunction	•Kidney function should be adequately monitored before LT. •Combined liver-kidney transplantation should be reserved for patients according to internationally recognised indications.
Malignancies	•Screening for pre-LT malignancies should follow the same protocols applied to patients with no-NAFLD related cirrhosis. •Particular attention should be paid to the gastrointestinal tract and genital system.

HbA1c, glycated haemoglobin; LT, liver transplant; NAFLD, non-alcoholic fatty liver disease; OGTT, oral glucose tolerance test.