Mas30 LIVER GRAFTS were associated with lower graft survival in recipients with MASLD, a form of steatotic liver disease characterised by metabolic dysfunction and fat accumulation in the liver. The pattern was not seen in recipients with metabolic dysfunction and alcohol-related liver disease (MetALD) or alcohol-associated liver disease (ALD).
The findings came from 27,164 adult liver transplant recipients recorded in the US transplant registry between 2014 and 2024. Of these, 14,270 had steatotic liver disease and 12,894 did not, with use of Mas30 grafts declining over the study period. Liver grafts were categorised according to the degree of donor macrovesicular steatosis, with none defined as less than 5%, mild as 5–30%, and Mas30 as more than 30%.
Among MASLD recipients, 90-day graft survival was 87.8% with Mas30 grafts, compared with 93.6% for mildly steatotic grafts and 95.3% for grafts with no steatosis (p<0.001). Three-year graft survival was 83.0%, 86.6% and 87.5%, respectively (p=0.01).
After adjustment, Mas30 grafts were linked to almost three times the risk of early graft failure in MASLD recipients (adjusted hazard ratio 2.93; P<0.001). The elevated risk persisted at three years (adjusted hazard ratio 1.66; p=0.002).
No corresponding association was identified among MetALD or ALD recipients, with all p values above 0.17. Competing-risk analyses supported the findings in MASLD, with sub-distribution hazard ratios of 3.18 for early and 2.18 for long-term outcomes. These additional analyses supported the main finding, showing the same pattern of reduced graft survival in MASLD patients at both early and long-term follow-up.
The results suggested that treating steatotic liver disease as a single category could overlook clinically relevant differences between recipient groups. This is reinforced by the fact that receiving a Mas30 graft was linked with reduced graft survival extending to three years after transplantation in MASLD patients, whereas no corresponding association was identified in MetALD and ALD recipients.
The authors concluded that the findings supported aetiology-specific allocation strategies for steatotic liver grafts. However, the study showed associations rather than establishing that Mas30 grafts directly caused poorer outcomes.
Reference
Sierra L et al. 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. HepatoBiliary Surg Nutr. 2026;15(4):97.
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