ArticleHepatobiliary surgery and nutrition2026
Liver donor macrosteatosis is associated with adverse long-term outcomes exclusively in metabolic dysfunction-associated steatotic liver disease recipients: a U.S. transplant registry analysis over the last decade.
Article in Hepatobiliary surgery and nutrition, 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: Liver grafts with >30% macrovesicular steatosis (Mas30) have shown acceptable long-term graft survival (GS) in steatotic liver disease (SLD) recipients. However, grouping SLD etiologies under a single umbrella ignores their distinct metabolic profiles and may lead to suboptimal allocation decisions. Considering the 2023 Delphi consensus nomenclature, we aimed to compare early and long-term GS following Mas30 liver transplantation (LT) across SLD subtypes. Methods: We analyzed adult LT recipients in the U.S. national transplant registry from 2014 to 2024. Donor macrovesicular steatosis was categorized as none (<5%), mild (5-30%), and Mas30 (>30%). SLD recipients were classified as metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction and alcohol-related liver disease (MetALD), or alcohol-associated liver disease (ALD). Primary endpoints were early (90-day) and long-term (3-year) GS. Time-to-event analyses were conducted using Kaplan-Meier and multivariable Cox regression. Results: Among 27,164 LT recipients (14,270 SLD and 12,894 non-SLD), Mas30 utilization declined over time (P<0.001). MASLD recipients of Mas30 grafts had reduced early GS (87.8% Conclusions: MASLD recipients receiving Mas30 grafts experience substantially reduced GS extending to 3 years post-LT, while MetALD and ALD recipients remain unaffected. Our findings support etiology-specific allocation strategies for steatotic liver grafts.
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