Fig. 2. Screening algorithm for post-liver transplant patients.

Annual screening for NAFLD is recommended, with an ultrasound. If NAFLD is identified or suspected by ultrasound or elevated liver enzymes, noninvasive testing can be performed by a combination of transient elastography with serum biomarkers, such as FIB-4. If mild fibrosis (≤F1) is present, lifestyle changes, including diet and weight loss, are recommended. If significant fibrosis (≥F2) is suspected, a liver biopsy is recommended. If findings are confirmed, a multidisciplinary approach should be adopted to assist with weight loss and management of metabolic syndrome co-morbidities.