BACKGROUND: Gallstone disease (GD) is the most frequent pathology of the biliary system and patients with end-stage liver disease (ESLD) are especially prone to develop it. It is difficult to treat such patients due to their poor general condition and decreased liver function. The aim of this study was to evaluate the prevalence of GD in liver transplant candidates and to investigate its associations with selected variables in the context of ESLD. ----- METHODS: This cross-sectional study included 101 non-diabetic adult cirrhotic patients transplanted between 2014 and 2017 at University Hospital Merkur, Zagreb. GD was confirmed postoperatively on the explanted specimens. Clinical and laboratory parameters were collected from the medical records. The insulin resistance index (IRI) values >1.7 were considered as insulin resistance (IR). ----- RESULTS: The prevalence of GD was 26.73%. The cohort consisted of 79 male and 22 female patients with a mean age of 57.39±8.79 years. Patients were divided into GS (gallstone)-present (n=27) and GS-absent groups (n=74). No statistically significant differences regarding age, gender, body mass index, aetiology or severity of liver disease (CTP or MELD score) between the two groups (p=ns) were noted. GS-present group had significantly higher alkaline phosphatase (ALP) 145 (range 44–306) IU/L and haemoglobin (Hgb) 113±25 g/L levels compared to the GS-absent group (ALP 109 (42–531) IU/L, p=0.031; Hgb 104±21 g/L, p=0.048). GD-present group had a significantly higher proportion of IR patients (IRI>1.7 31% vs IRI<1.7 5.9%) compared to the GS-absent group (IRI>1.7 69% vs IRI<1.7 94.1%) and higher fasting plasma glucose levels (5.44±0.74 mmol/L vs 5.22±0.62 mmol/L, p=0.029). ----- CONCLUSION: Liver transplant (LT) candidates have a high prevalence of GD (26.73%). IR is a hallmark of metabolic disturbances in cirrhosis, and may play an important role in the development of GD, which warrants further research.