Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2019; 25(13): 1628-1639
Published online Apr 7, 2019. doi: 10.3748/wjg.v25.i13.1628
Systematic review with meta-analysis on transplantation for alcohol-related liver disease: Very low evidence of improved outcomes
Nicole T Shen, Cristina Londono, Stephanie Gold, Ashley Wu, Keith C Mages, Robert S Jr Brown
Nicole T Shen, Robert S Jr Brown, Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY 10021, United States
Cristina Londono, Ashley Wu, Department of Medicine, Weill Cornell Medical College, New York, NY 10021, United States
Stephanie Gold, Department of Medicine, Division of Internal Medicine, Weill Cornell Medicine, New York, NY 10021, United States
Keith C Mages, Department of Medicine, Weill Cornell Medical College, Samuel J. Wood Library and C.V. Starr Biomedical Information Center, New York, NY 10021, United States
Author contributions: Shen NT contributed to conception and design of study, acquisition of data, analysis and interpretation of data, drafting the article, final approval; Londono C contributed to acquisition of data, drafting the article, final approval; Gold S contributed to acquisition of data, drafting the article, final approval; Wu A contributed to drafting the article, critical revision, final approval; Mages KC contributed to conception and design of study, acquisition of data, final approval; Brown RS Jr contributed to conception and design of study, analysis and interpretation of data, critical revision, final approval.
Supported by the Agency for Healthcare Research and Quality, No. T32HS 000066-24 from.
Conflict-of-interest statement: The authors deny any conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Nicole T Shen, MD, MSc, Doctor, Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, 1305 York Avenue 4th Floor, New York, NY 10021, United States. nts9004@nyp.org
Telephone: +1-646-9628690 Fax: +1-646-9620114
Received: February 6, 2019
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
Processing time: 58 Days and 23.6 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

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.

Research methods

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.

Research results

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.

Research conclusions

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.

Research perspectives

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.