Association of iron overload with infectious complications in liver transplant recipients: a systematic review and meta-analysis

Abstract

Objective This study was performed to examine the possible association of iron overload with infectious complications and survival among liver transplant recipients. Methods We conducted a systematic review and meta-analysis of studies published in the PubMed, Embase, Web of Science, and Cochrane Library databases up to September 2022. Hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted to estimate the association of iron overload with infectious outcomes and overall survival after liver transplantation. Results Eight studies involving 2817 recipients met the inclusion criteria. Iron overload was strongly associated with an increased risk of infection after liver transplantation (HR, 1.66; 95% CI, 1.03–2.68). An increase in the serum ferritin level was associated with an increased risk of infection after liver transplantation (HR, 1.44; 95% CI, 1.09–1.91). Iron overload was a significant predictor of worse overall survival (HR, 1.35; 95% CI, 1.11–1.64). In addition, a high serum ferritin level was significantly associated with an increased risk of death (HR, 1.34; 95% CI, 1.10–1.64). Conclusion Iron overload may be associated with a higher risk of infectious complications and a worse prognosis among liver transplant recipients.