酒精性肝病患者早期肝移植后酒精复发:一项 Meta 分析。

IF 1.4 Q4 GASTROENTEROLOGY & HEPATOLOGY Gastroenterology Research Pub Date : 2024-02-01 Epub Date: 2024-02-28 DOI:10.14740/gr1674
Yousaf Zafar, Ahmed Kamal Siddiqi, Nafhat Shaikh, Maria Imran, Syed Sarmad Javaid, Laila Manzoor, Arsalan Zafar Iqbal, Jan Petrasek
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引用次数: 0

摘要

背景:酒精使用障碍(AUD)是终末期肝病和肝功能衰竭的重要原因,也是肝移植(LT)的适应症之一。一直以来,酒精性肝病(ALD)的肝移植需要戒酒 6 个月。最近的研究表明,严格筛选出的早期 LT(戒酒时间小于 6 个月)患者可获得生存益处,同时将有害饮酒的复发率控制在可接受的水平。这种做法已在达拉斯共识中得到反映,但还需要更多的数据,以便从移植后复发有害饮酒的角度对患者进行适当的风险分层。这一 "6 个月规则 "一直备受争议,最近的数据表明,移植前戒酒时间的长短与移植后复酒风险的增加无关。我们进行了一项荟萃分析,以比较标准 LT 与早期 LT 患者的酒精复发率:方法:在 MEDLINE 和 SCOPUS 中检索了从开始到 2022 年 6 月的随机对照试验 (RCT)、观察性研究和病例对照研究。本荟萃分析遵循了 2009 年系统综述和荟萃分析首选报告项目(PRISMSA)核对表指南。纳入的研究比较了标准 LT 与早期 LT 患者移植后的结果,如酒精复发。综述、病例研究、会议摘要、仅有摘要的临床试验以及提取数据不充分的研究均被取消资格。对数据进行检索、收集和检查。采用随机效应模型生成森林图。在分析中,P 值为 0.05 即为显著:初步搜索发现了 34 项研究。本系统综述和荟萃分析纳入了三项研究,共纳入 367 名患者。平均年龄为 51.7 岁。在 367 名患者中,173 人(47%)接受了早期 LT。在纳入的三项研究中,一项研究表明接受早期LT治疗的患者酒精复发的概率降低,而另外两项研究的结果则相反。所有纳入的研究均经过分析,偏倚风险极低。汇总分析表明,早期 LT 与标准 LT 在酒精复发率方面的差异并不显著(几率比:1.24,95% 置信区间:0.75 - 2.06,P = 0.40):我们的研究结果表明,与强制戒酒 6 个月相比,早期 LT 与移植后酒精复发风险增加无关。因此,不应仅以戒酒 6 个月为标准,断然拒绝 ALD 患者接受 LT。应根据需要和移植后的结果采用其他选择标准。
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Alcohol Relapse After Early Liver Transplantation in Patients With Alcoholic Liver Disease: A Meta-Analysis.

Background: Alcohol use disorder (AUD) is a significant source of end-stage liver disease and liver failure and an indication for liver transplant (LT). Historically, LT for alcoholic liver disease (ALD) required 6 months of alcohol abstinence. Recently, it has been demonstrated that early LT (< 6 months of abstinence) in strictly selected group of patients provides survival benefit while keeping the relapse to harmful drinking at acceptable levels. This practice has been reflected in the Dallas consensus, but more data are needed to appropriately risk stratify the patient from the perspective of return to harmful alcohol drinking post-transplant. This "6-month rule" has been highly debated and recent data demonstrated that the duration of pre-transplant sobriety is not related with an increased risk of relapse to alcohol post-transplant. We performed a meta-analysis to compare the rate of alcohol relapse in individuals having standard vs. early LT.

Methods: MEDLINE and SCOPUS were searched for randomized controlled trials (RCTs), observational studies, and case-control studies from their inception through June 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMSA) 2009 checklist guidelines were followed for this meta-analysis. Studies comparing post-transplant outcomes, such as alcohol relapse, in individuals following standard vs. early LT, were included. Reviews, case studies, conference abstracts, clinical trials with only an abstract, and studies with inadequate data for extraction were all disqualified. The data were retrieved, gathered, and examined. The random effects model was used to generate forest plots. For the analysis, a P-value of 0.05 was considered significant.

Results: Thirty-four studies were discovered in the initial search. Three studies were included in this systematic review and meta-analysis incorporating 367 patients. Mean age was 51.7 years. Out of 367 patients, 173 (47%) underwent early LT. Out of three studies included, one study demonstrated decreased probability of alcohol relapse in patients undergoing early LT, whereas the other two showed the opposite result. All of the included studies were analyzed and had minimal risk of bias. Pooled analysis demonstrates that the difference in alcohol relapse between early vs. standard LT was insignificant (odds ratio: 1.24, 95% confidence interval: 0.75 - 2.06, P = 0.40).

Conclusion: Our results show that early LT is not associated with increased risk of alcohol relapse post-transplant when compared with a mandatory 6-month abstinence period. Hence, individuals with ALD should not be categorically rejected from LT merely on the criteria of 6 months of abstinence. Other selection criteria based on the need and post-transplant outcomes should be utilized.

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Gastroenterology Research
Gastroenterology Research GASTROENTEROLOGY & HEPATOLOGY-
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