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Updated: Oct 18, 2025
Author Spotlight: Evaluating Therapeutic Strategies to Enhance Liver Regeneration
Published on: May 24, 2024
Hepatic macrosteatosis in the US pediatric deceased liver donor population
Joshua W Purvis1, Babak J Orandi1, Deepti Dhall2
1Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Insights
Pediatric obesity is linked to increased liver macrosteatosis in young organ donors. However, this condition in pediatric liver allografts did not negatively impact recipient survival rates.
Area of Science:
- Hepatology
- Pediatric Gastroenterology
- Transplantation Medicine
Background:
- The rising prevalence of pediatric obesity correlates with increased instances of hepatic macrosteatosis.
- Hepatic macrosteatosis, a key feature of non-alcoholic fatty liver disease, may progress more rapidly in children than adults.
- While macrosteatosis in adult liver allografts is linked to graft loss, its impact in pediatric donors remains understudied.
Purpose of the Study:
- To investigate the prevalence of hepatic macrosteatosis in pediatric liver donors.
- To evaluate the association between macrosteatosis in pediatric liver allografts and recipient outcomes.
- To determine if macrosteatosis in pediatric donors affects allograft survival.
Main Methods:
- Analysis of pediatric deceased whole liver-only donor allografts from 2005-2018 with available biopsy data.
- Abstraction of macrosteatosis data from biopsy reports and comparison with standard records.
- Propensity score matching to compare recipients of macrosteatotic versus non-macrosteatotic pediatric allografts.
- Kaplan-Meier analysis and Cox proportional hazards models to assess all-cause allograft loss.
Main Results:
- The proportion of obese pediatric donors (age ≥2 years) increased from 14.8% to 21.7% between 2005-2018.
- The prevalence of macrosteatosis in pediatric deceased whole liver-only donor allografts rose from 1.8% to 3.9% during the study period.
- No significant differences in all-cause allograft loss were observed at 90 days or 1 year post-transplant between recipients of macrosteatotic and non-macrosteatotic pediatric allografts.
Conclusions:
- Obesity in pediatric liver donors has increased, correlating with a higher likelihood of hepatic macrosteatosis.
- Despite the increased prevalence, macrosteatosis in pediatric liver allografts did not demonstrate an adverse effect on recipient outcomes.
- These findings suggest that pediatric liver allografts with macrosteatosis may be safely transplanted without compromising short-term allograft survival.
Introduction:
The pediatric obesity epidemic is associated with early development of hepatic macrosteatosis, a hallmark of non-alcoholic fatty LI disease, which is thought to be more rapidly progressive in children than adults. Macrosteatosis in adult allografts is associated with allograft loss, but this has not been examined in pediatric donors.
Methods:
We studied all pediatric potential whole LI donors (2005-2018) who had a LI biopsy in the SRTR (n = 862) and whose LI was transplanted (n = 862). Macrosteatosis was abstracted from biopsy reports and compared to values in the SRTR standard analytic file. Recipients of macrosteatotic pediatric allografts were matched 1:1 to recipients of non-macrosteatotic pediatric allografts by propensity score matching on donor/recipient variables. All-cause allograft loss was estimated via Kaplan-Meier analysis and Cox proportional hazards model.
Results:
From 2005 to 2018, the proportion of pediatric donors (age ≥2 years) with obesity increased (14.8% to 21.7%; p < .001), as did the proportion of pediatric deceased whole LI-only donor allografts with macrosteatosis (n = 10 648; 1.8% to 3.9%; p < .001). The median degree of macrosteatosis among macrosteatotic donors was 10% (IQR 5-30). There were no significant differences in all-cause allograft loss between recipients of pediatric LI allografts with and without macrosteatosis at 90 days (p = .11) or 1 year (p = .14) post-transplant in Kaplan-Meier analysis or a Cox proportional hazards model (p > .05).
Conclusion:
Obese pediatric LI donors have increased over time and were more likely to have hepatic macrosteatosis; however, pediatric macrosteatosis did not appear to adversely affect recipient outcomes.
