Introduction: The metabolic syndrome (MetS) is a major contributor to cardiovascular disease and could influence long-term mortality after orthotopic liver transplantation (OLT). Methods: In this retrospective single-centre study of OLT recipients (n = 113) we aimed to identify the MetS prevalence and searched for risk factors associated with occurrence of MetS after OLT. Results: We identified a baseline MetS rate of 13.3 % in patients listed for OLT and could observe a strong increase in MetS rates to 47.8% within two years after OLT (P < 0.0001). The major factors contributing to MetS were increased low-density lipoprotein and reduced highdensity lipoprotein serum levels after OLT. The high MetS rate was observed as early as 6 months after OTL and maintained for the next two years after OLT. Multivariate logistic regression analysis identified HbA1c levels above 5% (odds ratio = 8.7; 95% confidence interval = 2.45 - 390.96, P < 0.001) and arterial hypertension (odds ratio = 4.21, 95% confidence interval = 1.08 - 21.44, P = 0.038) as independent risk factors in patients awaiting OLT. MetS incidence was reduced in patients receiving steroid-sparing immunosuppressive regimens (odds ratio = 0.12, 95% confidence interval = 0.05 - 0.085, P = 0.029) or in patients with a complete glucocorticoid tapering within 120 days after OLT (odds ratio = 0.20, 95% confidence interval = 0.02 - 0.62 P = 0.011), respectively. Conclusion: Our data confirmed the high prevalence of MetS after OLT and we were able to identify robust risk factors for MetS after OLT. Our data also indicated that glucocorticoid avoidance is a useful tool to reduce the rate of MetS after OLT. Beside this MetS prevention could be provided to patients showing a high risk profile by life style interventions.