Steatotic livers are not used for transplantation because they have a reduced tolerance for ischemic events with reduced ATP levels and greater levels of cellular necrosis, which ultimately result in total organ failure. Mitochondrial uncoupling protein-2 (UCP2) is highly expressed in steatotic livers and may be responsible for liver sensitivity to ischemia through mitochondrial and ATP regulation. To test this hypothesis, experiments were conducted in lean and steatotic (ob/ob), wild-type, and UCP2 knock-out mice subjected to total warm hepatic ischemia/reperfusion. Although ob/ob UCP2 knock-out mice and ob/ob mice have a similar initial phenotype, ob/ob UCP2 knock-out animal survival was 83% when compared with 30% in ob/ob mice 24 h after reperfusion. Serum alanine aminotransferase concentrations and hepatocellular necrosis were decreased in the ob/ob UCP2 knock-out mice when compared with ob/ob mice subjected to ischemia. Liver ATP levels were increased in the ob/ob UCP2 knock-out animals after reperfusion when compared with the ob/ob mice but remained below the concentrations from lean livers. Lipid peroxidation (thiobarbituric acid-reactive substances) increased after reperfusion most significantly in the steatotic groups, but the increase was not affected by UCP2 deficiency. These results reveal that UCP2 expression is a critical factor, which sensitizes steatotic livers to ischemic injury, regulating liver ATP levels after ischemia and reperfusion.Complications from liver steatosis represent a significant clinical concern, especially for liver surgeries including resection and transplantation. This is of escalating importance as nonalcoholic fatty liver disease is independently correlated to obesity and insulin resistance, which are both epidemic in the Unites States (1, 2). Steatotic livers are considerably more sensitive to acute stressors including ischemia/reperfusion (I/R) 2 as experienced in transplantation, and organs meeting this criterion are routinely turned down for donation (3-6). Under I/R conditions, steatotic livers are ATP-depleted, and the predominant hepatocellular fate is shifted from apoptosis to oncotic necrosis, strongly implicating inappropriate energy homeostasis as the primary cause of liver sensitivity (7-10).In a state of energy substrate abundance and forward shift in cellular redox potential, hepatocytes are thought to combat mitochondrial electron transport chain-derived reactive oxygen species (ROS) production through mitochondrial uncoupling. In normal lean livers, mitochondrial uncoupling protein-2 (UCP2) is confined to Kupffer cells; however, hepatocellular concentrations of UCP2 greatly increase with steatosis (7,11,12). Although the mechanism is not known, UCP2 facilitates passive proton conductance across the mitochondrial inner membrane into the matrix during respiration (13,14). Maximum employment of electrochemical potential at ATP synthase is sacrificed by UCP2, and heat, rather than ATP, is produced. Proton conductance is thought to require posttranslational activ...