Outcomes of Nonalcoholic Steatohepatitis After Liver Transplantation: An Updated Meta-Analysis and Systematic Review,Clinical Gastroenterology and Hepatology

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Outcomes of Nonalcoholic Steatohepatitis After Liver Transplantation: An Updated Meta-Analysis and Systematic Review
Clinical Gastroenterology and Hepatology ( IF 11.6 ) Pub Date : 2021-11-18 , DOI: 10.1016/j.cgh.2021.11.014
Jie Ning Yong ₁ , Wen Hui Lim ₁ , Cheng Han Ng ₁ , Darren Jun Hao Tan ₁ , Jieling Xiao ₁ , Phoebe Wen Lin Tay ₁ , Snow Yunni Lin ₁ , Nicholas Syn ₁ , Nicholas Chew ₂ , Benjamin Nah ₃ , Yock Young Dan ₄ , Daniel Q Huang ₅ , Eunice Xiang Xuan Tan ₅ , Arun J Sanyal ₆ , Mazen Noureddin ₇ , Mohammad Shadab Siddiqui ₆ , Mark D Muthiah ₅

Affiliation

Yong Loo Lin School of Medicine.
Department of Cardiology, National University Heart Centre.
Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore.
Yong Loo Lin School of Medicine; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore; Cancer Science Institute of Singapore, National University of Singapore, Singapore.
Yong Loo Lin School of Medicine; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore.
Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia.
Cedars-Sinai Fatty Liver Program, Division of Digestive and Liver Diseases, Department of Medicine, Comprehensive Transplant Center, Cedars-Sinai Medical Centre, Los Angeles, California.

Background & Aims

Nonalcoholic 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.

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 hazard ratios 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

Fifteen studies involving 119,327 LT recipients were included in our analysis with a prevalence of NASH of 20.2% (95% CI, 12.9–30.2). The pooled 1-year, 5-year, and 10-year all-cause mortality in NASH patients after LT were 12.5%, 24.4%, and 37.9%, respectively. Overall survival was comparable between LT recipients for NASH vs non-NASH (hazard ratio, 0.910; 95% CI, 0.760 to 1.10; P = .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 = .0026).

Conclusions

This study shows that patients undergoing LT for 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.

中文翻译：

肝移植后非酒精性脂肪性肝炎的结局：更新的荟萃分析和系统评价

背景与目标

非酒精性脂肪性肝炎 (NASH) 是肝移植 (LT) 增长最快的适应症，预计在不久的将来将成为 LT 的主要原因。NASH 的全身发病机制增加了接受 LT 的 NASH 患者出现不良临床结果的风险。因此，本研究旨在使用风险比对患有和不患有 NASH 的 LT 接受者进行时间依赖性生存分析。

方法

在 Medline 和 Embase 数据库中搜索了与 NASH 接受者 LT 结局相关的文章。使用具有元回归的 DerSimonian 和 Laird 随机效应模型对风险比进行生存分析。为了考虑审查，根据已发表的 Kaplan-Meier 曲线重建了生存数据，并将其汇总，以得出 LT 后 NASH 患者的更准确的危险估计和全因死亡率。进行配对荟萃分析来分析次要结果。

结果

我们的分析中纳入了涉及 119,327 名 LT 接受者的 15 项研究，其中 NASH 患病率为 20.2%（95% CI，12.9-30.2）。LT 后 NASH 患者的 1 年、5 年和 10 年全因死亡率合计分别为 12.5%、24.4% 和 37.9%。NASH 与非 NASH 的 LT 接受者之间的总生存率相当（风险比，0.910；95% CI，0.760 至 1.10；P = .34）。Meta 回归显示，与非 NASH 患者相比，终末期肝病评分较高的模型与 LT 后 NASH 患者的总生存率显着较差相关（95% CI，-0.0856 至 -0.0181；P = .0026 ）。