Cardiovascular (CV) disease has a significant impact on post-liver transplantation (LT) survival. Finding surrogate markers for occult CV disease would improve CV assessment in the LT evaluation. This study was designed to determine the prevalence of microvascular disease (MVD) and the utility of both microalbuminuria and the homeostatic model for insulin resistance (HOMA-IR) for assessing the presence of MVD in potential LT recipients. In this study, we examined the prevalence of MVD in 72 diabetics and 71 nondiabetics; both groups were matched for age, sex, race, and etiology of cirrhosis while awaiting LT. We prospectively collected data including fasting serum insulin and glucose levels, urine creatinine and microalbumin, and macrovascular and microvascular complications. MVD was present in 58 (40.5%) patients; MVD was more common in diabetics (n ฯญ 45, 62.5%) than nondiabetics (n ฯญ 13, 18.3%). The presence of diabetes mellitus (DM; P ฯญ 0.03), insulin use (P ฯญ 0.002), and duration (months) of DM (85.3 ฯฎ 96.1 versus 22.1 ฯฎ 46.3, P ฯฝ 0.0001), hypertension (51.3 ฯฎ 101.5 versus 22.7 ฯฎ 58.2, P ฯญ 0.03), and hypertriglyceridemia (7.2 ฯฎ 17.4 versus 3.8 ฯฎ 18.5, P ฯญ 0.04) were associated with MVD. Significant microalbuminuria had a sensitivity of 85%, a specificity of 100%, and a positive predictive value of 100% for the presence of MVD. HOMA-IR also was associated with MVD (P ฯญ 0.0001). In conclusion, at our center, 62.5% of DM patients and 18% of non-DM patients awaiting LT have MVD. Patients with DM, significant microalbuminuria, or an elevated HOMA-IR should undergo rigorous CV assessment prior to LT.