Background: Outcomes after liver resection (LR) and liver transplantation (LT) for hepatocellular carcinoma (HCC) are heterogenous and may vary by region, over time periods and disease burden. We aimed to compare overall survival (OS) and disease-free survival (DFS) between LT versus LR for HCC within the Milan criteria.Methods: Two authors independently searched Medline and Embase databases for studies comparing survival after LT and LR for patients with HCC meeting the Milan criteria. Meta-analyses and metaregression were conducted using random-effects models.Results: We screened 2,278 studies and included 35 studies with 18,421 patients. LR was associated with poorer OS [hazard ratio (HR) =1.44; 95% confidence interval (CI): 1.14-1.81; P<0.01] and DFS (HR =2.71; 95% CI: 2.23-3.28; P<0.01) compared to LT, with similar findings among intention-to-treat (ITT) studies. In uninodular disease, OS in LR was comparable to LT (P=0.13) but DFS remained poorer (HR =2.95; 95% CI: 2.30-3.79; P<0.01). By region, LR had poorer OS versus LT in North America and Europe (P≤0.01), but not Asia (P=0.25). LR had inferior survival versus LT in studies completed before 2010 (P=0.01), but not after 2010 (P=0.12). Cohorts that underwent enhanced surveillance had comparable OS after LT and LR (P=0.33), but cohorts undergoing usual surveillance had worse OS after LR (HR =1.95; 95% CI: 1.24-3.07; P<0.01).Conclusions: Mortality after LR for HCC is nearly 50% higher compared to LT. Survival between LR and LT were similar in uninodular disease. The risk of recurrence after LR is threefold that of LT.

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aimed to assess the association between depression and NAFLD. Methods A search of the literature was conducted on Medline and Embase databases to identify articles relating to NAFLD and depression. A meta-analysis of proportions was conducted using the generalized linear mix model with Copper Pearson intervals to stabilize the variance. Risk factors were analyzed using the odds ratios and mean difference for dichotomous and continuous variables respectively. To compare between the rate of depression between NAFLD (non-alcholic fatty liver disease) and NASH (nonalcoholic steatohepatitis), the relative risks (RR) were calculated using the depression in NASH vs NAFLD as the ratio of the pooled proportion and confidence interval by the Katz-logarithmic method. Results Of 1315 unique abstracts identified, 10 articles involving 2,041,752 NAFLD patients were included (IDDF2021-ABS-0008 Figure 1. Overall Prevalence of Depression in NAFLD). In a pooled analysis of studies, there was a significant relationship between the diagnosis of depression and NAFLD (OR: 1.29, CI: 1.02 -1.64, p=0.03). The overall pooled prevalence of depression in NAFLD was14.39% (CI: 8.89% -22.45%). The prevalence of depression in nonalcoholic steatohepatitis (NASH) is 40.68% (CI: 25.11% -58.37%), significantly higher than that in NAFLD at 14.39% (CI: 8.89% -22.45%). Compared to NAFLD, patients with NASH had a significantly higher risk of depression (RR: 2.83, CI: 2.41 -3.32, p <0.001). Diabetes, BMI, female sex, history of smoking and history of lung disease were significant risk factors associated with depression in NAFLD patients and depression in NAFLD patients was an independent predictor of all-cause 1-year mortality. Conclusions To our knowledge, this is the first meta-analysis to describe a positive association between NAFLD and depression with an increasing rate of depression in NASH compared to NAFLD (IDDF2021-ABS-0008 Figure 2. Graphical Depiction of the Overall Results). However, more studies are required to observe the impact of depression and clinical outcomes in NAFLD.