Recipient outcomes of salvage liver transplantation versus primary liver transplantation: A systematic review and meta-analysis.
ABSTRACT BACKGROUND: Salvage liver transplantation (SLT; liver resection followed by liver transplantation) has been performed after primary liver resection for many years. However, the true outcomes and risks of SLT relative to primary liver transplantation (PLT) remain unclear. METHODS: We performed a systematic review and meta-analysis to evaluate the survival rate and incidence of postoperative complications of SLT recipients. Of the 2,799 references screened, seven eligible studies were identified. RESULTS: The meta-analysis results indicated no statistically significant difference in the overall survival rate between SLT and PLT, with the pooled relative risk being 0.99 (95% confidence interval (CI), 0.90 to 1.09, p = 0. 867) at 1 year, 0.97 (95% CI, 0.83 to 1.13, p = 0. 675) at 3 years and 0.96 (95% CI, 0.81 to 1.13, p = 0. 613) at 5 years. With respect to postoperative complications, the incidence of sepsis and biliary complication showed no statistically significant difference between SLT and PLT, but there was a significantly higher incidence of bleeding with SLT (relative risk, 2.84; 95% CI, 1.57 to 5.13; p = 0. 001). CONCLUSION: SLT has similar overall survival to that of PLT. Given the limited organ donor pool, SLT might be an acceptable therapy for patients undergoing primary liver resection for HCC. Liver Transpl, 2012. © 2012 AASLD.
- SourceAvailable from: Christoph Erwin Minder[show abstract] [hide abstract]
ABSTRACT: Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30% of the trial); analysis of funnel plots from 37 meta-analyses identified from a hand search of four leading general medicine journals 1993-6 and 38 meta-analyses from the second 1996 issue of the Cochrane Database of Systematic Reviews. Degree of funnel plot asymmetry as measured by the intercept from regression of standard normal deviates against precision. In the eight pairs of meta-analysis and large trial that were identified (five from cardiovascular medicine, one from diabetic medicine, one from geriatric medicine, one from perinatal medicine) there were four concordant and four discordant pairs. In all cases discordance was due to meta-analyses showing larger effects. Funnel plot asymmetry was present in three out of four discordant pairs but in none of concordant pairs. In 14 (38%) journal meta-analyses and 5 (13%) Cochrane reviews, funnel plot asymmetry indicated that there was bias. A simple analysis of funnel plots provides a useful test for the likely presence of bias in meta-analyses, but as the capacity to detect bias will be limited when meta-analyses are based on a limited number of small trials the results from such analyses should be treated with considerable caution.BMJ 10/1997; 315(7109):629-34. · 14.09 Impact Factor
- BMJ (Clinical research ed.). 10/2003; 327(7414):557-60.
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ABSTRACT: Salvage liver transplantation has been performed for recurrent hepatocellular carcinoma (HCC) or deterioration of liver function after primary liver resection. Because prior liver resection per se is an unfavorable condition for living donor liver transplantation (LDLT), we assessed the technical feasibility of LDLT after prior hepatectomy, and we compared the outcome of salvage LDLT with that of primary LDLT in HCC patients. Of 342 patients with HCC, 17 (5%) underwent salvage LDLT, with 5 having undergone prior major liver resection and 12 prior minor resection. During salvage LDLT, 12 patients received right lobe grafts, 3 received left lobe grafts, and 2 received dual grafts. There was 1 incident (5.9%) of perioperative mortality. Recipient operation time was not prolonged in patients undergoing salvage LDLT, but bleeding complications occurred more frequently than in patients undergoing primary LDLT. Overall survival rates after salvage LDLT were similar to those after primary LDLT, especially when the extent of recurrent tumor was within the Milan criteria. These results indicate that every combination of prior hepatectomy and living donor liver graft is feasible for patients undergoing salvage LDLT, and the acceptable extent of HCC for salvage LDLT is equivalent to that for primary LDLT.Liver Transplantation 06/2007; 13(5):741-6. · 3.94 Impact Factor