Metabolic syndrome, non-alcoholic fatty liver disease and graft inflammation: an unaddressed pathogenic link after kidney transplantation.

Kidney transplantation (KT) is the treatment of choice for chronic kidney disease (CKD) patients, but there is a continued loss of grafts in the long-term (50% at 10 years) due to either patient 's death or chronic allograft dysfunction. Metabolic syndrome (MS) is very prevalent after KT (30-40%) and its components contribute to the appearance of non-alcoholic fatty liver disease/metabolic dysfunction-associated fatty liver disease (NAFLD/MAFLD) and non-alcoholic steatohepatitis (NASH), which represents the hepatic component of MS. Furthermore, about 20-40% of KT recipients present early graft inflammation, including subclinical inflammation.