Era of metabolic dysfunction-associated steatotic liver disease and impact on the liver donor pool

Table 2 Risk factors associated with liver steatosis in grafts from living and deceased brain-dead donors

Factor	Living donor	Deceased donor	Ref.
Age (years)	> 40	> 50	[96-98]
BMI (kg/m²)	> 25	> 30	[96,98]
Sex	Male	Male	[96,98]
Metabolic syndrome	Diabetes, hypertension, dyslipidemia	Common, often underdiagnosed	[45,97]
MASLD	Personal or family history	High prevalence, especially in obese individuals	[45]
Alcohol consumption (g/day)	> 20	> 40 chronically (> 5 years) or recent acute use	[45]
Preoperative assessment	Imaging (MRI, US, CAP) + selective biopsy	Limited, visual or back table biopsy if available	[34,36,99,100]
Perimortem conditions	N/A	Hypoxia, sepsis, prolonged support (> 72 hours MV, > 48 hours vasopressors, > 5 days in the ICU)	[101]
Cold ischemia	30-60 minutes	> 10 hours	[97]
Expected outcome	Minimal damage, good recovery	Higher risk of dysfunction due to ischemia and steatosis	[102]
Graft preservation	Excellent (scheduled)	Variable (depending on logistics and center)	[102]

BMI: Body mass index; MASLD: Metabolic dysfunction-associated steatotic liver disease; MRI: Magnetic resonance imaging; US: Ultrasound; CAP: Controlled attenuation parameter; N/A: Not applicable; MV: Mechanical ventilation; ICU: Intensive care unit.