P0982 - A Second Chance at Life: Role of Early Liver Transplantation in Improving Survival for Severe Alcoholic Hepatitis -- A Systematic Review and Meta-Analysis
Anvesh Narimiti, MD1, Vinay Jahagirdar, MD2, Mithil Gowda Suresh, MD3, Amrutha Jagaragallu, MD4, Moulika R. Bandaru, MD3, Kaanthi Rama, MD4, Rakesh Vinayek, MD5 1Harvard School of Public Health, Boston, MA; 2University of Missouri-Kansas City, Kansas City, MO; 3Saint Vincent Hospital, Worcester, MA; 4Gandhi Medical College & Hospital, Hyderabad, Telangana, India; 5Sinai Hospital, Baltimore, MD
Introduction: Patients with severe alcoholic hepatitis (SAH), who do not respond to medical therapy, have a high risk of 6-month mortality up to 80%. Studies have shown survival benefits after early liver transplantation (LT) in selected patients with SAH, without the 6-month abstinence period. We performed a meta-analysis to determine 6-month and 12-month survival in these patients, compared to matched controls who did not undergo LT.
Methods: Multiple databases, including PubMed and Embase, were searched from inception to April 2023. Outcomes of interest included survival among patients with AH who received LT vs those who did not receive LT. Pooled odds ratios were estimated by the random effects model by employing DerSimonian and Laird method, using Stata.
Results: An initial database search yielded 1122 articles, of which 107 studies were identified for full-text review. In the final analysis, 3 studies were finally included, with a cumulative study population was 188, of which 51 underwent early LT for SAH. Pooled demographics include: 62.8% males, a mean age of 33.7 years, mean MELD score of 33.7. The pooled OR for 6-month survival for the LT group compared to the non-transplant group was 10.36 (95% CI 0.79, 16.13, p=0.01), with I2 40.51%, showing moderate heterogeneity. Pooled OR for 1-year survival was 5.55 (95% CI 2.01-15.32, p< 0.001).
Discussion: In conclusion, our meta-analysis firmly establishes that early LT is a lifesaving intervention for patients with SAH not responding to medical therapy. The survival benefits are more pronounced at 6 months and 1 year. Therefore it is critical to recognize and leverage this intervention in more centers and think again about the need for 6 months of abstinence prior to LT.
Figure: A: Forest plot showing 6-month survival in patients with severe alcoholic hepatitis with and without early liver transplantation B: A: Forest plot showing 12-month survival in patients with severe alcoholic hepatitis with and without early liver transplantation
Disclosures:
Anvesh Narimiti indicated no relevant financial relationships.
Vinay Jahagirdar indicated no relevant financial relationships.
Mithil Gowda Suresh indicated no relevant financial relationships.
Amrutha Jagaragallu indicated no relevant financial relationships.
Moulika R. Bandaru indicated no relevant financial relationships.
Kaanthi Rama indicated no relevant financial relationships.
Rakesh Vinayek indicated no relevant financial relationships.
Anvesh Narimiti, MD1, Vinay Jahagirdar, MD2, Mithil Gowda Suresh, MD3, Amrutha Jagaragallu, MD4, Moulika R. Bandaru, MD3, Kaanthi Rama, MD4, Rakesh Vinayek, MD5. P0982 - A Second Chance at Life: Role of Early Liver Transplantation in Improving Survival for Severe Alcoholic Hepatitis -- A Systematic Review and Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
