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

Alcohol-associated hepatitis (AH) is a severe manifestation of alcohol-associated liver disease (ALD) with significant global health implications. Evaluating the efficacy of early liver transplantation (eLT) for AH patients, irrespective of the conventional six-month abstinence rule, may impact clinical guidelines. This study aimed to compare post-liver transplantation outcomes between AH patients adhering to six months of abstinence versus those who do not.

A comprehensive search was conducted across PubMed, Scopus, Embase, Cochrane, and Web of Science databases. Studies involving AH patients undergoing eLT, with or without six months of abstinence were included. Data were pooled using a random-effects model to account for study heterogeneity, assessed by I² and chi-squared tests.

This meta-analysis included 5990 ALD patients from 42 predominantly retrospective cohort studies. The overall survival rate was 85%, with survival rates of 89% at 1 year, 81% at 2 years, 78% at 5 years, and 60% at 10 years. Among 15 studies comparing eLT to standard LT, there was no significant difference in survival (RR: 1.00, 95% CI:0.97-1.02). The overall graft survival rate was 75% (95% CI:0.68-0.81), with no significant difference between eLT and standard LT (RR: 0.95, 95% CI:0.90-1.01). The overall relapse rate post-eLT was 19% (95% CI:0.16-0.23), increasing from 7% at 6 months to 24% at 10 years. There was no significant difference in relapse rates between eLT and standard LT (RR: 1.34, 95% CI:0.96-1.88).

This comprehensive meta-analysis underscores the efficacy of eLT as a treatment option for severe AH, challenging the conventional six-month abstinence rule. These findings suggest that the six-month abstinence rule may not be a reliable predictor of post-transplant outcomes in AH patients.