Predictors for Survival After Liver Transplantation in Nonalcoholic Steatohepatitis

Surgeons performing liver transplant. Samsung Medical Center, Seoul, South Korea.
Researchers sought to identify predictive factors for survival after liver transplantation among patients with nonalcoholic steatohepatitis.

Several risk factors, especially older age and pretransplant diabetes, influence survival after liver transplantation of patients with nonalcoholic steatohepatitis (NASH), according to study findings published in EClinicalMedicine.

Researchers conducted a systematic review and meta-analysis without date limits of the following databases: Ovid MEDLINE ALL, Ovid Embase, the Cochrane Database of Systematic Reviews, and the Cochrane Register of Controlled Trials. The searches were performed on June 18, 2020 and April 28, 2022. Researchers identified 8583 potential studies and included 25 in the systematic review and 5 in the meta-analysis upon further review.

In the systematic review, risk factors predicting overall survival of patients with NASH after liver transplantation included:

  • patient age
  • patient functional status according to the Karnofsky Performance Scale
  • preliver transplantation hepatoma
  • preliver transplantation dialysis
  • the model for end-stage liver disease (MELD) score
  • pretransplant diabetes
  • portal vein thrombosis
  • hepatic encephalopathy
  • hospitalization in the intensive care unit at liver transplantation
  • liver transplantation year

Additionally, in the systematic review, researchers discovered that patient age, body mass index, pretransplant diabetes, and pretransplant dialysis all impacted survival of the new graft after liver transplantation.

Following a pooled meta-analysis of 5 of the 25 studies, older age (over 65 years) of the transplant recipient and pretransplant diabetes increased risk for death after liver transplantation in patients with NASH.

“This evidence may form the foundation for prognostication and resource allocation decisions in patients undergoing [liver transplantation] for NASH,” the study authors said. “It may also suggest, with a low degree of evidence, that post[liver transplantation] mortality may be augmented in these patients through control of [diabetes].”

Study limitations include lack of randomization, the possibility of false-positive findings, and the exclusion of many studies secondary to a more conservative approach for excluding duplicate cohorts, exclusion of non-English texts, and application of a body mass index cutoff of greater than 30.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of the author’s disclosures.

Reference

Minich A, Arisar FAQ, Shaikh NUS, et al. Predictors of patient survival following liver transplant in non-alcoholic steatohepatitis: A systematic review and meta-analysis.  EClinicalMedicine. 2022;50:101534. doi:10.1016/j.eclinm.2022.101534