Clinical outcomes of early versus standard liver transplantation in patients with alcohol-related liver disease: a meta-analysis.

BACKGROUND

A 6-month abstinence period before listing patients with alcohol-related liver disease (ALD) for liver transplantation (LT) is the current standard practice at many transplant centers worldwide. Its prognostic validity is, however, debated because it has not been prospectively validated, and because many ALD patients do not survive long enough to make it onto the waitlist.

METHODS

A meta-analysis was conducted in accordance with the guidelines put forth by Cochrane and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Three databases (PubMed/Medline, Scopus and Cochrane Library) were searched to identify studies comparing early (eLT) and standard LT (sLT).

RESULTS

Twelve studies comparing eLT and sLT for ALD were included, encompassing 2323 patients with ALD. Mortality [Risk ratio (RR) = 0.94, 95% Confidence Interval (CI): 0.73-1.22] and patient survival [Hazard Ratio (HR) = 1.10, 95% CI: 0.83-1.45] did not differ significantly between eLT and sLT. Any alcohol relapse was more frequent following eLT but did not reach significance in the primary analysis (RR = 1.37, 95%CI: 0.95-2.00). This association became statistically significant on leave-one-out and subgroup analyses. Early LT patients had a higher risk of acute graft rejection (RR = 1.22, 95% CI: 0.98-1.52) but comparable graft loss (RR = 0.97, 95% CI: 0.74-1.27). Post-operative risk of infection did not differ significantly (RR = 1.19, 95% CI: 0.80-1.77), but eLT was associated with longer hospitalization [Mean Difference (MD) = 5.24 days, 95% CI: 0.15-10.33].

CONCLUSIONS

Early LT offers survival similar to sLT and is a reasonable option when medical therapy fails. However, the equivocal evidence of higher morbidity and alcohol relapse, and the longer hospitalization, support careful multidisciplinary selection and close post-transplant surveillance, particularly among recipients with alcohol-related hepatitis.