A team from the Queen Elizabeth Hospital, Birmingham, England conducted a retrospective analysis of patients who had an orthotopic liver transplantation for primary biliary cirrhosis (PBC) between 1983 and 1999.
Four hundred consecutive patients were analyzed, with a mean follow-up of 56 months.
The team found that, in their center, the proportion of patients grafted for PBC fell progressively - from 35 per cent in 1990 to 21 per cent in 1999.
Comparison of patients grafted in the 2 decades showed that the median age increased from 53 to 56 years, and the median serum bilirubin at transplantation fell from 270 µmol/L to 132 µmol/L.
Survival after 1, 5,and 10 years:
Patient 83, 78 and 67%
Graft 82, 75 and 61%
The overall actuarial patient and graft survivals at 1, 5 and 10 years were 83 per cent, 78 per cent and 67 per cent, and 82 per cent, 75 per cent and 61 per cent, respectively.
The net gain in 5-year survival, compared with predicted survival in the absence of transplantation, fell from 37 per cent to 16 per cent.
Multiple organ failure (16.1 per cent) and sepsis (9.6 per cent) were the major causes of early deaths.
Recurrent PBC, diagnosed on allograft histology, was found in 68 patients, at a mean time of 36 months.
The researchers were unable to identify any pre-transplantation donor or recipient factor, which identified those patients at risk of recurrence. Recurrence was much earlier, and seen more frequently, in patients receiving tacrolimus.
Dr. James Neuberger concluded on behalf of the group that, "PBC remains a good indication for liver transplantation, with excellent survival rates.
"The age at transplantation increased, although patients tended to be grafted earlier. Survival rates have increased, although there is a reduction in the survival benefit. Recurrence may be common, but does not seem to affect medium-term graft survival."