Waitlist and Post-Transplant Outcomes in Liver Transplantation for Alcohol-Associated Liver Disease: An Individual Patient Data Meta-Analysis.
Ho, G. J. K., et al.Aliment Pharmacol Ther. 2026 Feb;63(3):330-340.
Aims
The main aim of the study was to investigate waitlist and post-transplant outcomes in liver transplant patients with alcohol-associated liver disease (ALD) compared to those without ALD.
Interventions
Medline and Embase were searched for relevent literature. Study selection and data extraction were performed by two independent reviewers. The risk of bias was assessed using the Newcastle–Ottawa scale.
Participants
50 studies were included in the review.
Outcomes
The primary waitlist endpoints included waitlist survival and removal from the waitlist due to improvement. Primary post-transplant endpoints were overall survival and graft survival. The secondary endpoints included likelihood of post-transplant complications.
Follow-up
N/A
CET Conclusions
This systematic review and meta-analysis explores the literature comparing waitlist and post-transplant outcomes in patients undergoing liver transplantation for alcoholic versus non-alcoholic liver disease. The analysis includes 50 articles in over 380,000 patients and concludes that overall waitlist and post-transplant graft and patient survival do not differ between groups. Whilst the post-transplant survival curves do appear to diverge beyond 5 years post-transplant, the overall hazard ratio is not significant. Risk of de-novo malignancy appears to be higher in patients undergoing transplant for alcoholic liver disease. Whilst the analysis is described as an “individual patient meta-analysis” (IPMA) – this is not strictly true. The authors extract patient data from published Kaplan-Meier plot, meaning that there is no individual patient information on potential confounders to allow for an adjusted analysis as would be the case in a true IPMA. As most of the studies are observational in nature and it is unclear whether individual studies were adjusted for confounders, there is a relatively high risk of selection bias. Coupled with high heterogeneity in many of the analyses, this does somewhat weaken the strength of conclusions in what is an interesting and otherwise well described analysis.
Trial registration
N/A