Pérez-Escobar J, Huerta-Álvarez A, Castro-Narro GE, Astudillo-Delgado MI, Carpinteyro-Espin P. Era of metabolic dysfunction-associated steatotic liver disease and impact on the liver donor pool. World J Gastroenterol 2025; 31(37): 110164 [DOI: 10.3748/wjg.v31.i37.110164]
Corresponding Author of This Article
Paulina Carpinteyro-Espin, MD, Professor, Researcher, Department of Transplantation, Hospital Juárez de México, Avenue Instituto Politécnico Nacional 5160, Mexico City 07760, Mexico. paucarpi@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Juanita Pérez-Escobar, Paulina Carpinteyro-Espin, Department of Transplantation, Hospital Juárez de México, Mexico City 07760, Mexico
Aline Huerta-Álvarez, Department of Nutrition, Hospital Juárez de México, Mexico City 07760, Mexico
Graciela Elia Castro-Narro, Hepatology and Transplant Unit, Hospital Médica Sur, Mexico City 14050, Mexico
Graciela Elia Castro-Narro, Department of Gastroenterology, Hepatology and Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
María Isabel Astudillo-Delgado, Department of Gastroenterology, Hospital Juárez de México, Mexico City 07760, Mexico
Author contributions: Pérez-Escobar J, Huerta-Álvarez A, Castro-Narro GE, and Carpinteyro-Espin P conceptualized the study; Pérez-Escobar J, Huerta-Álvarez A, and Carpinteyro-Espin P revised the subsequent versions; Pérez-Escobar J and Carpinteyro-Espin P generated the figures and tables; all authors performed the investigation, wrote the first draft, and agreed to the published version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Paulina Carpinteyro-Espin, MD, Professor, Researcher, Department of Transplantation, Hospital Juárez de México, Avenue Instituto Politécnico Nacional 5160, Mexico City 07760, Mexico. paucarpi@gmail.com
Received: June 3, 2025 Revised: July 7, 2025 Accepted: August 29, 2025 Published online: October 7, 2025 Processing time: 117 Days and 21.2 Hours
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) has emerged as a silent epidemic having substantial clinical implications, with liver transplantation being one of the areas most impacted. The increasing prevalence of metabolic fatty liver disease has reduced the quality of available donor organs. While noninvasive methods are increasingly applied to evaluate liver steatosis in deceased donors, liver biopsy remains the gold standard. Many aspects of liver biopsies are not yet fully standardized. Macrovesicular hepatic steatosis is associated with decreased allograft quality and poorer short- and long-term transplant outcomes, especially in moderate and severe steatotic cases. Donation after cardiac arrest further exacerbates these poor outcomes. Matching marginal allografts with suitable recipients based on recipient characteristics is crucial for improving transplant outcomes. Living donor liver transplant is a feasible option for addressing organ shortages. Noninvasive evaluation is preferred for assessing liver health; however, when the results are inconclusive, a liver biopsy is recommended. Lifestyle modifications can improve graft, living donor and recipient outcomes. Analysis of the impact of MASLD on the donor pool and the implementation of new optimization strategies are essential to ensure the sustainability of transplantation as a curative treatment for advanced liver cirrhosis. The aim of this review was to summarize the effect of MASLD on the liver donor population, highlighting how to evaluate steatosis in donors, and to discuss its clinical implications as well as strategies to optimize organ allocation in the MASLD era.
Core Tip: Metabolic dysfunction-associated steatotic liver disease has been associated with a decline in the quality of available donor organs. Evaluation of liver graft steatosis is crucial for optimizing the donor pool. To maximize transplant success, decision-making algorithms need to be established, taking into account the degree of steatosis, donor characteristics, ischemia time, and recipient variables. New technologies and artificial intelligence represent future valuable tools.
