Figure 1.

Assessment of suspected steatotic donor liver. The initial assessment of a donor liver is performed by the procuring surgeon. Tactile and visual characteristics indicative of steatosis (yellow color, exceptionally soft liver, friability, enlarged, round edges) will usually lead the surgeon to request a biopsy if an unacceptable amount of steatosis is suspected. In the absence of these characteristics, the liver is considered to be low risk, and transplantation can proceed. On biopsy, the percent sd‐MaS, ld‐MaS, and inflammation/fibrosis is assessed. Isolated sd‐MaS of any amount and mild (<30%) ld‐MaS are generally considered safe for transplantation. Conversely, moderate (30%‐60%) or severe (>60%) ld‐MaS, or other types of steatosis in the presence of other risk factors for poor outcome (inflammation, fibrosis) will lead to an individualized decision, although usually these livers are discarded.