Early Liver Transplantation for Alcohol-Associated Hepatitis: A Systematic Review and Meta-Analysis

Area of Science:

• Hepatology
• Transplantation Medicine
• Gastroenterology

Background:

• Alcohol-associated hepatitis (AH) is a severe form of alcohol-associated liver disease (ALD).
• The conventional six-month abstinence rule for liver transplantation in AH patients is being re-evaluated.
• Early liver transplantation (eLT) may offer a viable treatment option for severe AH.

Purpose of the Study:

• To compare post-liver transplantation outcomes for AH patients who adhered to the six-month abstinence rule versus those who did not.
• To evaluate the efficacy of eLT for AH patients irrespective of the six-month abstinence period.

Main Methods:

• A systematic meta-analysis was conducted using data from PubMed, Scopus, Embase, Cochrane, and Web of Science.
• Included studies focused on AH patients undergoing eLT, with or without prior abstinence.
• Data were pooled using a random-effects model to address study heterogeneity.

Main Results:

• The meta-analysis included 5990 ALD patients from 42 studies, with an overall survival rate of 85%.
• No significant differences in survival or graft survival were observed between eLT and standard LT.
• Post-eLT relapse rates were 19% overall, with no significant difference compared to standard LT.

Conclusions:

• eLT is an effective treatment for severe AH, questioning the necessity of the six-month abstinence rule.
• The six-month abstinence rule may not be a reliable predictor of post-transplant outcomes in AH patients.
• Findings support considering eLT for eligible AH patients without strict adherence to the abstinence period.