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Figure 1. Multifactorial treatment of pre-transplant MASLD. Increased physical activity and optimization of both diet and medical comorbidities are universally recommended. Patients with non-lean MASLD should aim for at least 5%-10% weight loss. Pharmacologic therapeutic options are continuing to expand with the recent approval of a MASH-specific option (resmetirom). Endoscopic bariatric therapies and bariatric surgery represent invasive but effective modalities to achieve significant weight loss and improve metabolic comorbidities. MASLD: Metabolic dysfunction-associated steatotic liver disease; MASH: metabolic dysfunction-associated steatohepatitis.