Liver transplant is the most effective therapeutic option for patients with end-stage liver disease, nonalcoholic steatohepatitis, and acute liver failure. We evaluated whether the percentage of hepatic fat percentage affected transplant outcomes to determine whether livers with varying severity of macrosteatosis should be considered suitable for donation.We analyzed data from 381 patients with liver failure who received liver transplant at Montaseriyeh Hospital in Mashhad, Iran, between 2013 and 2022. Clinical and demographical data were collected, and we examined frozen-section slides of pretransplant biopsy specimens from donor livers. Liver allograft macrosteatosis was categorized into 4 groups according to severity of steatosis: 30%.The mean age of recipients was 49 years; mean age of donors was 37 years. The mean liver survival rate was approximately 56 months. A total of 115 recipients (30%) died after liver transplant, with graft rejection as the leading cause of death (38%). Grafts with hepatic macrosteatosis <10% contributed to the largest share (87%). No significant differences were observed in the indication for liver transplant, life outcome, cause of death after liver transplant, or mean rate of liver survival among the 4 groups. Also, there was no significant correlation between the severity of liver macrosteatosis and graft or patient survival.Our findings suggest that livers with varying degrees of macrosteatosis are safe for transplant and should not be excluded from the donor pool.