Outcomes of liver transplantation for nonalcoholic steatohepatitis: a systematic review and meta-analysis.
OBJECTIVE
Little is known about outcomes of patients with nonalcoholic steatohepatitis (NASH) who receive liver transplants. We performed a systematic review and meta-analysis to estimate post-transplant outcomes, survival times, and mortality from cardiovascular complications, sepsis, and graft failure in these patients.


METHODS
We searched PubMed and EMBASE, and Cochrane library and Web of Science databases for studies published through September 1, 2012 of patients who underwent liver transplantation for NASH or nonalcoholic fatty liver disease (NAFLD). All original studies from single institutions that reported outcomes of patients with or without NASH after liver transplantation were considered. Odds ratios (ORs) were calculated for patients with NASH, compared with patients without NASH; 95% confidence intervals (CIs) were calculated.


RESULTS
Our final analysis included 9 publications, on 717 patients with NASH and 3520 without, all of whom underwent liver transplantation. Similar proportions of patients with and without NASH who received liver transplants survived for 1, 3, and 5 years (OR for survival of patient with NASH 1 year after liver transplantation, 0.77; 95% CI, 0.59-1.00; P = .05; OR 3 years after transplantation, 0.97; 95% CI, 0.67-1.40; P = .86; OR 5 years after transplantation, 1.09; 95% CI, 0.77-1.56; P = .63). Patients with NASH had a greater risk of death from cardiovascular complications after liver transplantation (OR, 1.65; 95% CI, 1.01-2.70; P = .05) and from sepsis (OR, 1.71; 95% CI, 1.17-2.50; P = .006). However, patients with NASH were at lower risk of graft failure compared with patients without NASH (OR, 0.21; 95% CI, 0.05-0.89; P = .03).


CONCLUSIONS
Similar proportions of patients with and without NASH survive for 1, 3, and 5 years after liver transplantation. However, patients with NASH are more likely to die from cardiovascular complications or sepsis. More attention and careful consideration are therefore required in selecting patients with NASH for liver transplantation, along with aggressive management of cardiovascular complications and sepsis after transplantation.
Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Institute of Hepato-Biliary-Pancreas and Intestinal Disease, North Sichuan Medical College, Nanchong, China.
Xiaofei
X
Wang
Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Institute of Hepato-Biliary-Pancreas and Intestinal Disease, North Sichuan Medical College, Nanchong, China; Department of Hepatobiliary Surgery, Chinese People's Liberation Army General Hospital, Beijing, China. Electronic address: docwxf@hotmail.com.
Jingdong
J
Li
Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Institute of Hepato-Biliary-Pancreas and Intestinal Disease, North Sichuan Medical College, Nanchong, China.
D R
DR
Riaz
Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Institute of Hepato-Biliary-Pancreas and Intestinal Disease, North Sichuan Medical College, Nanchong, China.
Gang
G
Shi
Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Institute of Hepato-Biliary-Pancreas and Intestinal Disease, North Sichuan Medical College, Nanchong, China.
Chongqing
C
Liu
Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, China; Institute of Hepato-Biliary-Pancreas and Intestinal Disease, North Sichuan Medical College, Nanchong, China.
Yi
Y
Dai
D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D005234:Fatty Liver / Q000150:complications / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation; D065626:Non-alcoholic Fatty Liver Disease; D018805:Sepsis / Q000453:epidemiology / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome
Liver Transplantation; Meta-analysis; Nonalcoholic Steatohepatitis