Effect of Graft Steatosis on the Early Outcome of Living Donor Liver Transplantation

Authors

• Kareem Maher Shams Eldeen Hassan, Resident at Department of general surgery , Gastrointestinal surgery ccenter,Faculty of Medicine, Mansoura university, Mansoura, Egypt.Follow
• Ahmed Mahmoud Abdelrafee, Lecturer at Department of general surgery, Gastrointestinal surgery ccenter,Faculty of Medicine, Mansoura university, Mansoura, Egypt
• Ahmed Mohamed Ibrahim Elsabbagh, Assistant Professor at Department of general surgery, Gastrointestinal surgery center, Faculty of Medicine, Mansoura university, Mansoura, Egypt.
• Mohamed Abd Elwahab Ali, Professor at Department of general surgery, Gastrointestinal surgery center, Faculty of Medicine, Mansoura university, Mansoura, Egypt

Subject Area

General Surgery

Article Type

Original Study

Abstract

Background

Hepatic steatosis in donor grafts represents a growing challenge in living donor liver transplantation (LDLT) due to the rising prevalence of metabolic syndrome. The impact of varying degrees of graft steatosis on recipient and donor outcomes remains incompletely defined.

Aim

To evaluate the effect of different degrees of graft steatosis on early postoperative outcomes in both recipients and donors following LDLT.

Methods

This retrospective study analyzed 169 LDLT cases performed at Mansoura University between January 2014 and June 2024. Donors aged 18-45 years with BMI≥5% on liver biopsy were included. Grafts were stratified by steatosis degree:20% (n=4). Primary outcome was early graft dysfunction. Secondary outcomes included postoperative complications, biochemical recovery, ICU and hospital stay, and survival rates in both recipients and donors.

Results

Graft steatosis showed a significant dose-dependent relationship with recipient complications (p=0.043), increasing from 52.8% in20% steatosis. Early graft dysfunction trended higher with increasing steatosis (27% vs 50%, p=0.056). However, biochemical recovery of liver function (AST, ALT, INR) was comparable across all steatosis groups (p>0.2). Cold ischemia time correlated significantly with steatosis severity (p=0.03). Importantly, donor outcomes were unaffected by graft steatosis, with no significant differences in complications (p=0.694), biochemical recovery, or major morbidity (p=0.470). Overall recipient survival was excellent: 97% at 1 year, 94% at 3 years, and 92% at 5 years

Conclusion

Graft steatosis significantly increases recipient morbidity in a dose-dependent manner but does not impair biochemical recovery or long-term survival when managed appropriately. Donor safety remains uncompromised. Grafts with mild to moderate steatosis (≤20%) can be safely utilized in LDLT with careful donor selection, preoperative optimization, and meticulous perioperative management. Minimizing cold ischemia time is particularly important for steatotic grafts.

Recommended Citation

Shams Eldeen Hassan, Kareem Maher; Abdelrafee, Ahmed Mahmoud; Elsabbagh, Ahmed Mohamed Ibrahim; and Elwahab Ali, Mohamed Abd (2026) "Effect of Graft Steatosis on the Early Outcome of Living Donor Liver Transplantation," Mansoura Medical Journal: Vol. 55 : Iss. 6 , Article 7.
Available at: https://doi.org/10.58775/2735-3990.1563

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