Long-term survival & impact of UDCA for rPBC after tx

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Liver Transpl. 2007 Sep;13

Long-term survival and impact of ursodeoxycholic acid treatment for

recurrent primary biliary cirrhosis after liver transplantation.

Charatcharoenwitthaya P, Pimentel S, Talwalkar JA, Enders FT, Lindor

KD, Krom RA, Wiesner RH.

Miles and Shirley Fitterman Center for Digestive Diseases, Mayo Clinic

and Foundation, Rochester, MN.

The recurrence of primary biliary cirrhosis (PBC) in the hepatic

allograft may impact patient and graft survival with long-term

follow-up. The efficacy of ursodeoxycholic acid (UDCA) for treatment

of recurrent PBC after liver transplantation (LT) remains less well

known. The aims of this study were as follows: 1) to determine the

significance of recurrent PBC on overall survival among PBC patients

who underwent LT, and 2) to determine the efficacy of UDCA treatment

after LT in patients with recurrent PBC. A retrospective cohort study

was conducted of 154 PBC patients who underwent LT with at least 1 yr

of follow-up after transplantation from 1985 through 2005. A total of

52 patients with recurrent PBC were identified. After adjusting for

age and gender, recurrent PBC was not associated with death or liver

retransplantation (hazard ratio, 0.97, 95% confidence interval,

0.41-2.31; P = 0.9). A total of 38 patients with recurrent PBC

received UDCA at an average dose of 12 mg/kg/day for a mean duration

of 55 months. Over a 36-month period, an estimated 52% of UDCA-treated

patients experienced normalization of serum alkaline phosphatase and

alanine aminotransferase compared to 22% of untreated patients. There

was no significant difference in the rate of histological progression

between subgroups. UDCA did not influence patient and graft survival.

In conclusion, the development of recurrent PBC has little impact on

long-term survival or need for retransplantation. While UDCA therapy

is associated with biochemical improvement, its role in delaying

histologic progression remains unknown. In this short period of

treatment, UDCA was not associated with improved patient and graft

survival compared to untreated patients. Liver Transpl 13:1236-1245,

2007. © 2007 AASLD.

PMID: 17763401 [PubMed - in process]