Waitlist and Post‐Transplant Outcomes in Liver Transplantation for Alcohol‐Associated Liver Disease: An Individual Patient Data Meta‐Analysis
Year: 2025
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: BACKGROUND AND AIMS: Alcohol-associated liver disease (ALD) is a rapidly rising indication for liver transplantation. Early studies showed comparable post-transplant outcomes but emerging data suggest long-term survival benefits in ALD, thus warranting an analysis of waitlist and post-transplant outcomes. METHODS: Medline and Embase were searched from inception to 16 May 2025. Kaplan-Meier curves were extracted to reconstruct individual participant data for pooled survival analysis of time-to-event outcomes using a random effects model. Cox regression-generated hazard ratios (HRs) for survival outcomes, and odds ratios (ORs) for post-transplant complications were obtained using pairwise meta-analyses. RESULTS: 50 articles (382,614 patients) were included in the meta-analysis. 6-month, 1- and 2-year waitlist survival in ALD patients was 79.7%, 72.7% and 63.8%, compared to 81.7%, 72.9% and 61.3% in non-ALD patients. 1-, 3-, 5- and 10-year post transplant patient survival was 91.3%, 83.0%, 76.1% and 60.2% in ALD, and 90.3%, 82.8%, 76.9% and 66.4% in non-ALD. Waitlist (HR: 1.021, 95% CI: 0.519-2.009, p = 0.95) and post-transplant survivals (HR: 0.914, 95% CI: 0.805-1.039, p = 0.17) were comparable between ALD and non-ALD patients. ALD patients had a higher risk of de novo malignancy post-transplant (OR: 2.194, 95% CI: 1.534-3.139, p < 0.001). CONCLUSION: In this reconstructed individual patient data meta-analysis, waitlist survival was comparable between ALD and non-ALD patients. While early post-transplant patient survival was similar, long-term survival remained inferior in ALD, partly attributed to increased de novo malignancy. These findings highlight the need for improved candidate selection, addiction care, and cancer surveillance to maximise long-term outcomes in the growing ALD transplant population.
DOI: 10.1111/apt.70434
Authors: Glenn Jun Kit Ho, Mirudhula Gnanavelou, Ryan Yanzhe Lim, Lucas Yang Yuxu Yeo, Benjamin Nah, Bryant Low, Talia Yi Hui Chan, Thanawin Pramotedham, Shi Yan Lee, Caleb Wei Hao Ng, Toru Nakamura, Hideki Fujii, Hirokazu Takahashi, Vincent L. Chen, Mazen Noureddin, Mark Muthiah, Wen Hui Lim, Mohammad Shadab Siddiqui, Eunice Xiang‐Xuan Tan
Institutions: National University of Singapore, National University Hospital, National University Health System, Kurume University, Osaka Metropolitan University, Saga University, University of Michigan, Michigan Medicine, Houston Methodist, Houston Methodist Research Institute, University of Virginia
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4415758762