Clinical evidence of outcomes following liver transplantation in patients with nonalcoholic steatohepatitis: An updated meta-analysis and systematic review. (August 2022)

• Record Type: Journal Article
• Authors: Zhou, Guang-Peng; Jiang, Yi-Zhou; Sun, Li-Ying; Zhu, Zhi-Jun
• Is Part Of: International journal of surgery. Volume 104(2022)
• Publication Date: 2022-08
• Subjects: Nonalcoholic steatohepatitis -- NASH -- Liver transplantation -- Nonalcoholic fatty liver disease -- Survival -- Outcome; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2022.106752
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Objective: Nonalcoholic steatohepatitis (NASH) is a dramatically growing indication for liver transplantation (LT) worldwide and the posttransplant outcomes of NASH patients are currently under intensive investigation. This quantitative meta-analysis aimed to update the clinical evidence on outcomes of transplanted patients with NASH. Methods: We performed a systematic review and meta-analysis of studies (published up to September 15, 2021) that focused on LT outcomes for NASH versus non-NASH patients. Random-effect meta-analysis was conducted to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses based on crucial baseline clinical characteristics and leave-one-out sensitivity analyses were conducted to assess the robustness of the pooled results. Meta-regression was used to evaluate study-level demographic, clinical, and biochemical characteristics to identify potential confounders affecting patient survival. Results: Twenty-two non-randomized comparative studies with 1, 538 NASH and 6, 014 non-NASH patients were included. 1- (OR, 0.94; 95% CI, 0.77–1.14), 3- (OR, 0.82; 95% CI, 1.00–1.22), and 5- (OR, 1.05; 95% CI, 0.84–1.31) year patient survival was equivalent between NASH and non-NASH recipients. NASH patients were associated with similar cardiovascular mortality (OR, 1.36; 95% CI, 0.89–2.09) and retransplantation rates (OR, 0.69; 95% CI, 1.03–1.53), lower graft failure-related mortality (OR, 0.11; 95% CI, 0.29–0.74), but higher sepsis-related mortality (OR, 1.53; 95% CI, 1.13–2.06). Meta-regression revealed that a higher proportion of patients with hepatocellular carcinoma (HCC) were associated with significantly superior overall patient survival at 1 ( P = 0.044), 3 ( P = 0.035) and 5 ( P = 0.049) years after LT in NASH compared with non-NASH. Conclusions: This study shows no difference in posttransplant survival between NASH and non-NASH patients. Carefully selected patients with NASH-related HCC may benefit from LT. NASH recipients should be managed with caution posttransplant, especially regarding the potentially high risk of sepsis-related death. Highlights: Data on the outcomes of nonalcoholic steatohepatitis (NASH) following liver transplantation (LT) should be updated. Pooled analysis shows that patients undergoing LT for NASH have comparable patient survival compared with non-NASH patients. Carefully selected patients with NASH-related hepatocellular carcinoma may benefit from LT.