Liver transplantation for alcoholic hepatitis: A systematic review with meta-analysis.
Marot A, Dubois M, et al.PLoS ONE 2018 [Electronic Resource] 13(1): e0190823.
Aims
To conduct a systematic review and meta-analysis to assess alcohol relapse and 6-month survival rates in transplanted patients with alcoholic hepatitis (AH) compared to patients with alcoholic cirrhosis who underwent elective liver transplantation and non-responders who were not transplanted.
Interventions
The databases Medline, Embase and the Cochrane library were searched until 10 June 2017 for studies published in all languages that included patients with AH who underwent liver transplantation, and included data relative to alcohol consumption or survival after liver transplantation. Manual searches were also conducted, and two reviewers screened abstracts presented presented between 2014 and 2017 at the Liver Meeting of the American Association for the Study of Liver Diseases and the International Liver Congress of the European Association for the Study of the Liver. Data extraction was performed independently by two investigators and discrepancies resolved by discussion, or consultation with a third author. Methodological quality of cohort studies was assessed using the Newcastle Ottawa Scale.
Participants
11 studies were included in the analysis.
Outcomes
The primary measured outcome was alcohol relapse defined as any alcohol consumption after liver transplantation. Secondary measured outcomes included harmful drinking defined as binge, frequent, regular or daily drinking, and 6-month survival.
Follow-up
6 months
CET Conclusions
This systematic review and meta-analysis investigates relapse rates in liver transplant recipients transplanted for alcoholic hepatitis. In the 11 studies identified, the pooled relapse rate was 22%, reduced to 14% when stringent selection criteria were applied. The authors argue that in selected patients, transplant for AH without a period of abstinence can be justified. Unfortunately, the review is hampered by poor quality, heterogeneous underlying evidence and publication bias. The authors present a number of subgroup analyses and comparisons with patients undergoing elective transplant for alcoholic cirrhosis, but significant heterogeneity and small study/patient numbers lead to wide confidence intervals and very few additional robust conclusions can be drawn. It is unclear how many of the comparisons and subgroup analyses were prespecified, as the review protocol was not prospectively registered with PRISMA.
Quality notes
Quality assessment not appropriate
Trial registration
None