ArticleClinical transplantation and research2026
Donor steatosis in the metabolic dysfunction-associated steatotic liver disease era: a retrospective analysis of challenges and outcomes in living donor liver transplantation.
Article in Clinical transplantation and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The increasing prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) among potential living donors poses unique challenges for living donor liver transplantation (LDLT). Traditionally, hepatic steatosis has restricted donor eligibility because of concerns regarding graft dysfunction and adverse recipient outcomes. However, evidence regarding the safety of using mildly to moderately steatotic grafts in LDLT remains limited. Methods: This retrospective study analyzed 1,511 adult-to-adult LDLTs performed at a tertiary center in New Delhi between July 2006 and September 2023. Donor hepatic steatosis was evaluated noninvasively using the computed tomography liver attenuation index and magnetic resonance imaging-proton density fat fraction. Donors were stratified into steatotic and nonsteatotic groups, and outcomes were compared between these groups. Recipient and donor perioperative data, postoperative complications, duration of hospital stay, and 1-year survival were assessed. Results: Of the 1,511 donors, approximately 23% exhibited mild to moderate steatosis. Steatotic donors were older and had higher body mass index and lipid profiles than nonsteatotic donors. Recipients of steatotic grafts received significantly larger grafts; however, there were no significant differences in major complications, length of hospital stay, or 1-year graft and patient survival compared with recipients of nonsteatotic grafts. No cases of primary nonfunction or early allograft dysfunction were observed in the steatotic group. Donor outcomes were similarly favorable. Conclusions: In carefully selected donors, mild to moderate hepatic steatosis may not be associated with adverse posttransplant outcomes in LDLT. Incorporating such donors may safely expand the donor pool amid the growing MASLD epidemic. Prospective studies are needed to further refine donor selection criteria.
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