Prevalence and impact of fatty liver disease in adult deceased liver transplant donors: MAFLD or NAFLD?

Donor hepatic steatosis is associated with worse post-liver transplant (LT) outcomes, especially when >30%(1). Such donors usually have non-alcoholic fatty liver disease (NAFLD) which is defined as fatty liver (hepatic steatosis >5%) without excessive alcohol consumption (>210g/week for men, >140g/week for women) or concomitant liver disease. Recently, international consensus have proposed that the term NAFLD be replaced by metabolic-associated liver disease (MAFLD)(2). New criteria define MAFLD as fatty liver together with the presence of metabolic conditions (i.e. type 2 diabetes mellitus, elevated ethnicity-specific body mass index (BMI), or at least two of: elevated waist circumference, hypertension, dyslipidemia, prediabetes, and/or insulin resistance)(2). We know these metabolic variables such as raised BMI and diabetes mellitus in a donor also contribute to graft marginality(1, 3). We examined whether a biopsy-proven diagnosis of NAFLD or MAFLD in a liver donor impacted on outcomes.