An approach to the rational use of steatotic donor livers in liver transplantation

Steatosis or fatty change is a common finding in donor liver biopsies durin g liver transplantation, and seems to be more frequent than in the general population. Fat can be stored in hepatocytes within macrovacuoles (macroste atosis) or microvacuoles (microsteatosis), with different degrees of severi ty. Higher degrees of both macro and microsteatosis may increase the severi ty of the ischemia-reperfusion lesion producing an initial poor function in the recipient. Different pathogenic mechanisms have been investigated. How ever, only severe macrosteatotic (>60%) grafts have been associated with pr imary non-function, and are universally rejected for transplantation. While donor livers with any severity of microsteatosis do not influence recipien t survival and can be safely implanted, donor Livers with moderate to sever e macrosteatosis (30-60%) have a relative risk of primary non-function and should be considered for transplantation in the absence of other known risk factors. A protocol with a rational use of these steatotic Livers is sugge sted.