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Introduction: Non-alcoholic fatty liver disease (NAFLD) is a growing public health issue. Non-invasive methods to assess the fibrosis stage are limited, and biopsy remains the gold standard. The objective of our study was to assess whether the portal venous pulsatility index (VPI) can be used as a predictor of high-risk NAFLD at a tertiary referral centre for liver transplantation. Methods: We retrospectively reviewed patients with biopsy-proved NAFLD who had undergone a liver ultrasound scan within 1 year of biopsy at our centre from 2011 to 2019. Results: We did not find a significant correlation between the VPI and the NAFLD risk category or correlation between the VPI and degree of steatosis (P > 0.05 for both). Conclusion: Since VPI can be easily obtained on routine liver ultrasound and since other studies do report a positive association with significant fibrosis, more studies are needed before it can be recommended or not in risk-stratifying NAFLD patients into highvs. low-risk NAFLD.