Liver and Bile
Clin Gastroenterol Hepatol. 2023;21(1):45–54.e6
Outcomes of non-alcoholic steatohepatitis after liver transplantation: An updated meta-analysis and systematic review
Background and aims: Non-alcoholic steatohepatitis (NASH) is the fastest growing indication of liver transplantation (LT) and is projected to be the leading cause of LT in the near future. The systemic pathogenesis of NASH increases risks of adverse clinical outcomes in patients with NASH receiving LT. Thus, this study aimed to conduct a time-dependent survival analysis between LT recipients with and without NASH using hazard ratios [HRs].
Methods: A search was conducted on Medline and Embase databases for articles relating to LT outcomes for NASH recipients. A survival analysis was conducted of HRs using the DerSimonian and Laird random-effects model with meta-regression. To account for censoring, survival data were reconstructed from published Kaplan-Meier curves and pooled to derive more accurate hazard estimates and all-cause mortality in NASH patients after LT. Pairwise meta-analysis was conducted to analyze secondary outcomes.
Results: 15 studies involving 119,327 LT recipients were included in this analysis with a prevalence of NASH of 20.2% (95% confidence interval [CI]: 12.9–30.2). The pooled 1-year, 5-year, and 10-year all-cause mortality in NASH patients after LT was 12.5%, 24.4%, and 37.9%, respectively. Overall survival was comparable between LT recipients for NASH versus non-NASH (HR = 0.910; 95% CI: 0.760–1.10; p = 0.34). Meta-regression showed that a higher Model for End-stage Liver Disease score was associated with significantly worse overall survival in NASH compared with non-NASH after LT (95% CI: -0.0856 to -0.0181; p = 0.0026).
Conclusions: This study shows that patients undergoing liver transplantation for non-alcoholic steatohepatitis (NASH) cirrhosis have comparable complication rates, overall survival, and graft survival compared with non-NASH patients, although close monitoring may be indicated for those with higher Model for End-stage Liver Disease scores.