Abstract
OBJECTIVES: Hepatic steatosis impacts the quality of grafts, affecting transplant outcomes. Rising obesity rates and subsequent donor graft steatosis further influence the organ shortage crisis in pediatric liver transplantation (LT). Our study aimed to evaluate how donor steatosis modulates the outcomes of pediatric LT. METHODS: We analyzed the United Network of Organ Sharing database for transplanted donor grafts from January 01, 2004, to April 30, 2024. We stratified pediatric (≤18 years) LT recipients into steatotic grafts, subdivided into <30% and ≥30%. Graft failure was assessed using Kaplan-Meier curves, and Cox proportional hazards models, with Lasso regression identifying key predictive variables. Gradient-boosting decision tree was used to assess the level of likelihood importance for post-LT survival. RESULTS: Five hundred and ninety-five pediatric LT recipients were included; 62 (10.4%) received donors with steatosis levels ≥30%. Survival rates for steatotic grafts ≥30% were 93.5% at 1 year, 89.9% at 5 years, and 84.4% at 10 years, compared to 94.7%, 89.5%, and 85.2% respectively, among steatotic grafts <30% (p = 0.72, p = 0.92, and p = 0.92). Donor age (adjusted hazard ratio [aHR]: 1.01, 95% confidence interval [CI]: 1.01-1.03), donation after cardiac death (DCD) (aHR: 10.68, 95% CI: 3.27-34.86), and recipient life support (aHR: 1.95, 95% CI: 1.19-3.20) were associated with an increased risk of mortality. CONCLUSION: Steatotic grafts in pediatric patients had acceptable outcomes. Predictors of mortality in steatotic grafts, including donor age, DCD, and recipient life support, underscore the complex interplay of multiple factors in post-LT outcomes.