Introduction: The shortage of donor pool forces us to optimize the use of donors. The macrosteatosis of the graft was considered as an exclusion criterion in past times, but nowadays they are no longer rejected only because of this finding. Material and methods: Between March 1990 and December 2009 we performed 1235 OLT. From this period we selected a sample of 490 patients with complete pathological data of the donor. All patients had a minimum 2 year follow-up. They were divided in 3 groups: group A: microsteatosis (158 patients), group B: macrosteatosis (78 patients), and group C: no steatosis (254 patients). We analyze the influence of steatosis over patient and graft survival. Results: We present 3 groups of patients with a mean age of donor: group A: 47.58±20; B 54±17, and C 45.87±20.7 years (p=0.007). The mean recipient age was: group A: 53.65±10, B 52.8±11.4, and C 52.18±11.6 (p=0.425).No statistical significant differences were observed with respect to hemoderivate transfusion, ICU stay, MELD, and MELD-sodium. Also, no differences were observed with respect to VHC infection and hepatocarcinoma (HCC). When comparing biliary complications (leaks and stenosis) between groups, no differences were observed, as well as those related to vascular complications (arterial and venous thrombosis). There were no statistical differences with respect to the number of primary graft dysfunction, nor the number of deaths during hospital stay between the groups. The actuarial recipient survival at 1, 3, 5, and 10 years was 77.8%, 70.2%, 62.6%, and 50.8%, in group A(donor with microsteatosis); 83.3%, 71.6%, 61.2%, and 44.7 % in group B(macrosteatosis); and 86.2%, 81.4%, 76.7%, and 61.6 % in group C (no steatosis) (p=0.002). The actuarial graft survival, with respect to the percentage of macrosteatosis(MS) at 1,3,5 and 10 years: < 30% MS: 84.9%, 71.55, 62.7% and 47.6% respectively. Between 30-40% of MS: 77.8%, 72.2%, 59.1% and 47.3% respectively. When MS>40%: 40%, 20%, 20% and 20% respectively (p=0.038) Conclusion: The grafts used with MS are associated with acceptable survival rates, as compared with the rest of grafts, except for those with MS more than 40%, which have to be rejected.