Journal of Gastrointestinal Surgery

, Volume 19, Issue 9, pp 1713–1724 | Cite as

Donor Hepatic Steatosis and Outcome After Liver Transplantation: a Systematic Review

  • Michael J. J. ChuEmail author
  • Anna J. Dare
  • Anthony R. J. Phillips
  • Adam S. J. R. Bartlett
Review Article



There is increasing need to expand availability of donor liver grafts, including steatotic livers. Steatotic liver is associated with poor outcome post-transplantation but with conflicting results in the literature. The aim of this systematic review was to evaluate the impact of steatotic livers on liver transplantation outcomes.


An electronic search of OVID Medline and Embase databases was performed to identify clinical studies that reported outcomes of steatotic livers in liver transplantation. Data were extracted, and basic descriptive statistics were used to summarise data pooled from individual clinical studies.


Ninety-two articles were identified, of which 34 met the inclusion criteria, and stratified analysis were performed. There was a lack of standardised definition of primary non-function or impaired primary function amongst the studies and description of type of steatosis. Severely (>60 %) steatotic grafts are associated with increased risk of poor graft function, whilst moderate–severe (>30 %) steatotic grafts are associated with decreased graft survival.


Available evidence showed increased risk of poor graft outcome in moderate–severe steatotic livers. A large prospective multi-centred trial will be required to identify the true risks of steatotic livers. Consistent definition of primary non-function/impaired primary function and description of type of steatosis is also required.


Fatty liver Graft survival Humans Survival rate Treatment outcome 



Alanine aminotransferase


Aspartate aminotransferase


Case–control study


Case report


Cohort study


Donation after circulatory death


Delayed non-function


Early allograft dysfunction


Extended criteria donor


Early graft dysfunction


International normalised ratio


Impaired primary function


Model for End-Stage Liver Disease


Not stated


Orthotopic liver transplantation




Primary dysfunction of graft


Primary non-function


Preferred Reporting Items for Systematic Reviews and Meta-analyses


Prothrombin time


Prothrombin time activity


Partial thromboplastin time




Relative risk


Serum glutamic oxaloacetic transaminases



This work was directly supported by the University of Auckland Faculty Research Development Fund, Maurice Wilkins Centre for Biodiscovery and the Maurice & Phyllis Paykel Trust.

Supplementary material

11605_2015_2832_MOESM1_ESM.docx (626 kb)
Table S1 (DOCX 625 kb)


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Copyright information

© The Society for Surgery of the Alimentary Tract 2015

Authors and Affiliations

  • Michael J. J. Chu
    • 1
    Email author
  • Anna J. Dare
    • 1
  • Anthony R. J. Phillips
    • 1
    • 2
    • 3
  • Adam S. J. R. Bartlett
    • 1
    • 2
    • 3
  1. 1.Department of Surgery, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
  2. 2.New Zealand Liver Transplant Unit (NZLTU)Auckland City HospitalAucklandNew Zealand
  3. 3.Maurice Wilkins Centre for Molecular BiodiscoveryUniversity of AucklandAucklandNew Zealand

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