Post-transplant metabolic complications, encompassing diabetes, hypertension, dyslipidemia, and obesity, affect approximately half of all liver transplant recipients. Recurrent or de novo metabolic dysfunction-associated steatotic liver disease represents an additional component of the post-transplant metabolic syndrome, is highly prevalent, and may progress to graft fibrosis. These complications significantly impact long-term outcomes by contributing to an increased risk of cardiovascular events, graft fibrosis, and chronic kidney disease. This chapter explores the factors influencing the development of post-transplant metabolic complications, including pre-existing recipient conditions, donor characteristics, and the effect of different immunosuppressive regimens. We further review current strategies for the management of each component of the post-transplant metabolic syndrome. Novel therapies for metabolic-dysfunction-associated steatotic liver disease are rapidly emerging, and it will be an important focus of future research to delineate their potential role and safety profile in the post-transplant population.