Ischemia-free Liver Transplantation Improves Outcomes in Steatotic Liver Transplantation: A Retrospective Cohort Study
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Background: The growing trend of obesity-related diseases has made the safe use of steatotic donor livers a critical challenge in liver transplantation. Conventional cold storage methods often fail to adequately protect these fatty livers from ischemia-reperfusion injury (IRI). Ischemia-free technology addresses this by maintaining a continuous oxygenated blood supply during the procedure. However, the protective potential of ischemia-free technology for steatotic donor livers still needs more investigation. Methods: A single-center retrospective cohort analysis included 231 patients receiving steatotic liver transplants between 2017 and 2024. Patients were grouped by preservation method: Ischemia-free liver transplantation (IFLT) or static cold storage (SCS). Outcomes compared included early graft function complications, and survival. Results: The IFLT group had a 20.5% rate of early allograft dysfunction (EAD), significantly lower than the 45.6% in the SCS group. Ischemia-free technology was protective after adjustment (aOR 0.26, 95% CI 0.12–0.55). Ischemia-free technology also reduced prolonged Intensive care unit (ICU) stay risk. The benefit of IFLT was more evident in predefined subgroups, including donors aged ≥50 years and grafts with mild macrovesicular steatosis (<30%). These subgroup signals indicate a practical way to prioritize IFLT when resources are limited. Conclusion: IFLT can be preferentially considered for older-donor steatotic grafts and for grafts with <30% macrovesicular steatosis. This risk-stratified use may improve early graft function while supporting broader utilization of marginal livers.
