Primary biliary cirrhosis recurs after orthotopic liver transplantation in up to one-third of patients.
These patients are typically asymptomatic, can be identified by abnormal liver biochemistries, and have evidence of histologic recurrence on liver biopsy.
The effect of treatment on recurrence has not been determined.
Dr Marion Peters and colleagues evaluated the factors associated with recurrent primary biliary cirrhosis.
The research team describes our experience using ursodeoxycholic acid treatment in this patient population.
The team followed 48 patients with primary biliary cirrhosis for at least 1 year post-orthotopic liver transplantation.
|Ursodeoxycholic acid improved serum alkaline phosphatase|
Of these patients, 27 developed abnormal serum alkaline phosphatase.
The researchers noted that 17 patients had evidence of recurrent primary biliary cirrhosis by liver biopsy.
Patients with recurrent primary biliary cirrhosis had a trend toward longer warm ischemia times.
The team observed that patients with recurrent primary biliary cirrhosis had a trend toward more episodes of acute cellular rejection in the first year posttransplant.
Donor or recipient age, donor and recipient cytomegalovirus status, and dose of immunosuppression did not correlate with recurrence of primary biliary cirrhosis.
The researchers noted that patients diagnosed with recurrent primary biliary cirrhosis were placed on ursodeoxycholic acid, 15 mg/kg daily.
In addition, the team noted that in the majority of the patients placed on ursodeoxycholic acid showed improvement in serum alkaline phosphatase.
Dr Peters' team concludes, “Recurrent primary biliary cirrhosis is not infrequent post-orthotopic liver transplantation.”
“Ursodeoxycholic acid can be used with some benefit post-orthotopic liver transplantation.”
“Treatment effects on long-term survival are not known.”