Published online Apr 7, 2019. doi: 10.3748/wjg.v25.i13.1628
Peer-review started: February 6, 2019
First decision: February 21, 2019
Revised: March 7, 2019
Accepted: March 11, 2019
Article in press: March 12, 2019
Published online: April 7, 2019
Alcohol-related liver disease (ALD) is a leading cause of liver failure and indication for liver transplantation, thus optimizing use of liver transplantation in this patient population is imperative. Systematically reviewing the literature, comparing transplanting ALD to not transplanting ALD is necessary to understand how to optimize use of liver transplantation in ALD and to direct future research.
Systematically reviewing the existing literature on the use of liver transplant compared to no-transplant in patients with ALD could help guide clinical care and future directions of research.
To help inform optimal use of liver transplantation in ALD and understand limitations of existing research to guide future research, we conducted a comprehensive systematic review.
We systematically reviewed the existing literature for studies comparing liver transplant to no-transplant with a primary outcome of both short- and long-term mortality and relapse. Pre-specified causes of heterogeneity included assessment and treatment of alcohol use disorder (AUD), definition of ALD, spectrum of ALD studied, assessment and rates of relapse, and study quality and bias.
We analyzed data from 10 studies including 1332 participants. While meta-analysis comparing liver transplant to no-transplant suggested improved mortality, relapse was found to be insignificant and both meta-analyses were limited by significant heterogeneity. Outcomes and heterogeneity improved with restriction to prospectively collected data; liver transplant in comparison to no-transplant had significantly reduced mortality and relapse with insignificant heterogeneity, though results remained limited by small-study effects. Overall, the quality of the evidence was very low.
Current systematic review with meta-analysis comparing liver transplant to no-transplant suggests a mortality and relapse benefit in heterogeneous, institution-specific populations with inherent bias.
To understand efficacy of liver transplantation for ALD on a global scale, formal recognition of the dearth of well-published literature on transplantation in this population is necessary, and there is an urgent need to standardize our approach to studying ALD. Such standardization should include assessment of the presence and treatment of AUD, the clinical definition of ALD, reporting the spectrum of the ALD population studied, data collection, and definition and detection of relapse.