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Updated: Nov 7, 2025
Author Spotlight: Evaluating Therapeutic Strategies to Enhance Liver Regeneration
Published on: May 24, 2024
Moderately Macrosteatotic Livers Have Acceptable Long-Term Outcomes but Higher Risk of Immediate Mortality
Jurgis Alvikas1, Andrew-Paul Deeb1, Dana R Jorgensen2
1Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Background And Aims:
Liver transplantation is the most effective treatment for end-stage liver disease (ESLD). Whether moderately macrosteatotic livers (30%-60%) represent a risk for worsened graft function is controversial. The uncertainty, in large part, is owing to the heterogeneous steatosis grading. Our aim was to determine the short- and long-term outcomes of moderately macrosteatotic allografts that were graded according to a standardized institutional protocol.
Methods:
We performed a retrospective analysis of transplants performed between 1994 and 2014. All patients with allografts biopsied pretransplantation were included. Relevant donor and recipient variable were recorded. Moderately macrosteatotic livers were compared with mildly macrosteatotic and nonsteatotic livers. Primary outcomes of interest were patient survival at 90 days, 1 year, and 5 years. Cox regression analyses were carried out to compare survival between the 2 groups.
Results:
We compared 65 allografts with moderate macrosteatosis and 810 with no or mild macrosteatosis. Patients with moderately macrosteatotic allografts were 2.69 times as likely to die within the first 90 days after transplant (75.1% vs 91.6% survival) after adjusting for donor age, donor race, recipient age, recipient race, recipient body mass index, recipient diabetes, presence of hepatocellular carcinoma, days on waitlist, Model for End-Stage Liver Disease (MELD) score at transplantation, cold ischemia time. However, for recipients who survive 90 days, moderately macrosteatotic allografts had comparable long-term survival.
Conclusion:
Our study shows that moderate macrosteatosis is a strong predictor of early but not late mortality. Further studies are needed to distinguish the specific cohort of patients for whom moderately macrosteatotic allografts will lead to acceptable outcomes.
Insights
Moderately macrosteatotic livers increase early mortality risk after liver transplantation but do not impact long-term survival for patients who recover. Further research is needed for patient selection.
Area of Science:
- Hepatology
- Transplantation Medicine
- Graft Viability
Background:
- Liver transplantation is the primary treatment for end-stage liver disease (ESLD).
- The impact of moderately macrosteatotic livers (30%-60% fat) on graft function remains debated due to inconsistent grading.
- Standardized assessment is crucial for evaluating moderately macrosteatotic allografts.
Purpose of the Study:
- To evaluate short- and long-term outcomes of liver allografts with moderate macrosteatosis.
- To compare outcomes using a standardized institutional protocol for steatosis grading.
Main Methods:
- Retrospective analysis of liver transplants performed between 1994 and 2014.
- Inclusion of allografts with pre-transplantation biopsies.
- Comparison of moderately macrosteatotic livers (n=65) against non-steatotic/mildly macrosteatotic livers (n=810).
- Cox regression analysis for patient survival at 90 days, 1 year, and 5 years.
Main Results:
- Patients receiving moderately macrosteatotic allografts had a 2.69-fold increased risk of 90-day mortality.
- Adjusted for multiple donor and recipient factors, including MELD score and cold ischemia time.
- Long-term survival (beyond 90 days) was comparable between groups for survivors.
Conclusions:
- Moderate macrosteatosis is a significant predictor of early post-transplant mortality.
- It does not appear to adversely affect long-term survival in patients who survive the initial 90-day period.
- Further research is required to identify specific patient cohorts benefiting from moderately macrosteatotic allografts.
