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Key points: Optimization of metabolic comorbidities is key and may require a combination of directed medical therapies and immunosuppression adjustment Experience with GLP1-RAs in the post-LT population is increasing and potential benefits appear promising Bariatric surgery after LT may offer metabolic and weight loss benefits, although the long-term effects on reducing MASLD/MASH are unknown CONCLUSION The prevalence of MASLD is predicted to continue growing, with parallel increases in MASH, advanced fibrosis and cirrhosis