Background: Steatotic grafts are more susceptible to ischaemia-reperfusion injury than are normal grafts. Therefore, using steatotic grafts for liver transplantation (LT) is associated with high primary dysfunction and decreased survival rates. The aim of this study is to evaluate the impact of graft steatosis on post-LT outcomes.

Methods: A retrospective cohort analysis of 271 LT recipients from 2005 to 2016 was performed, and patients were classified based on two types of steatosis, macrosteatosis (MaS) and microsteatosis (MiS). Each category was subdivided into 3 groups according to the degree of steatosis: no (<5%), mild (≥5% – <30%), and moderate (≥30% – ≤60%). The primary hospital stays and 6-month postoperative complications were analysed by the Clavien-Dindo classification system. Additionally, patient and graft survivals were studied.

Results: Significant differences were observed in grade III MaS (p-value = 0.019) and grade V MiS (p-value = 0.020). A high trend of early graft dysfunction was found in the moderate MaS and MiS groups, however they were not statistically significant (p-value = 0.199 and 0.282, respectively). Interestingly, the acute cellular rejection (ACR) rate was found to be inversely proportional to the degree of steatosis in both categories, but it did not reach a significant level (p-value = 0.161 and 0.111, respectively).

Conclusions: Excellent post-LT long-term outcomes using grafts with mild and moderate steatosis were determined. Further studies are needed to evaluate the newly proposed relationship between ACR and steatosis.