The effect of donor fatty liver on graft survival is still uncertain. The aim of this study was to determine the influence of steatosis on outcome of orthotopic liver transplantation among our recipients. In a retrospective design, we evaluated the effect of donor liver steatosis on postoperative liver function and prognosis. Data obtained from liver transplant data registry of Shiraz organ transplant center, Namazee Hospital. Liver biopsies were taken before transplantation, and reviewed by two pathologists. Pathology reports were divided in to 4 groups: Normal pathology, mild fatty change (10-30%), moderate (30-60%), and severe steatosis (>60%). Factors determining transplantation outcome such as early mortality, duration of ICU and hospital stay, clinical rejection episodes, and graft surgical complications were compared between subjects with donor liver steatosis and others. Data analysed by SPSS 13 package and survival rates were calculated by Kaplan-Meier test. Three-month survival rates in recipients without donor's liver fatty change, subjects with mild fatty change (10-30%), and those with moderate (30-60%) steatosis were 68%, 72%, and 76%, respectively, which were not significantly different (p>0.05). No pathology of severe fatty change was reported by pathologists. Furthermore, short term (hospital) mortality (20% vs 14.3% vs 21.2%), hospital stay (30.89 vs 29.93 vs 23.62 days), and length of ICU admission (5.06 vs 5.89 vs 4.39 days) were not significantly different. In addition, Child score of recipient, preop and post-op liver function enzyme changes were similar. Up to 60% donor liver fatty change was not found to be associated with worse prognosis in orthotopic liver transplantation. Hence, pre-op liver biopsy does not seem not be required as a routine pre-op procedure.