Metabolic syndrome and allograft non-alcoholic fatty liver disease (NAFLD) is a common occurrence after orthotopic liver transplantation (OLT). NAFLD and hepatitis C virus (HCV) are frequently associated. The association steatosis/HCV determines important implications for clinical practice: steatosis accelerates the progression of fibrosis and reduces the likelihood of obtaining a sustained virological response (SVR) with antiviral therapy. We have evidenced a strong correlation between body mass index (BMI), cholesterol, triglycerides (TGC) and hepatic percentage of steatosis. In subjects with BMI < 25 and TGC < 160 ng/ml, the chance of SVR was 48 times higher than that of non-response. The chances of SVR for patients with percentage of steatosis <15 were 12 times higher than that with higher percentage of steatosis value. Detection, prevention and management of metabolic disorders and NAFLD should be one of the primary objectives of all transplant teams.