The success of liver transplantation (LT) is one of the great achievements of modern medicine. Advances in medical management and surgical techniques have resulted in sequential improvements in outcomes, with overall 5-year survival rates approaching 70% (http:// www.unos.org). The last 2 decades have witnessed an evolution in the causes of death and graft loss after LT. Perhaps most impressively, step wise improvements in the efficacy and tolerability of immunosuppression have reduced chronic rejection to a relatively minor cause of graft loss. 1 As the frequency of immunological causes of graft loss and mortality has declined, other causes have become increasingly important. Cardiovascular disease, renal insufficiency, and malignancies are among the emerging important causes of mortality and graft loss after LT. Metabolic syndrome (MS) is a common thread of risk for each of these. The prevalence and etiology of posttransplant metabolic syndrome (PTMS) are thus of increasing interest to the transplant community.
The report by Laish et al. 2 in this issue of Liver Transplantation is very welcome in this regard. Laish et al. studied the records of 252 transplant recipients (mean age ΒΌ 54.5 6 2.8 years, proportion of men ΒΌ 57.9%) for pretransplant and posttransplant clinical and laboratory parameters of MS. Among the primary observations was the fact that rates of obesity [body mass index (BMI) > 30 kg/m 2 ], hypertriglyceridemia