Orthotopic liver transplantation is the only effective curative therapy for end-stage primary biliary cirrhosis.
Survival after orthotopic liver transplantation is excellent.
However, recent data have shown a recurrence rate of primary biliary cirrhosis of up to 32% after transplantation.
Dr Dietmar Jacoba and colleagues from Germany
investigated the course after disease recurrence.
The researchers particularly assessed liver function and survival with long-term follow-up.
The team performed 1553 liver transplantations in 1415 patients at the Charité, Virchow Clinic, between 1989 and 2003.
Protocol liver biopsies were taken after 1, 3, 5, 7, 10 and 13 years.
The team reported that 7% of patients suffered from histologically proven primary biliary cirrhosis.
|Patient survival after 15 years was 82%|
Primary immunosuppression consisted of cyclosporine or tacrolimus.
Immediately after orthotopic liver transplantation, all patients received ursodeoxycholic acid.
The research team withdrew corticosteroids 3 to 6 months after orthotopic liver transplantation.
The team noted that the median age of the 85 women and 15 men was 55 years.
The median follow-up after liver transplantation was 118 months, and 30 months after recurrence 30 months.
The researchers found that actuarial patient survival after 5, 10 and 15 years was 87%, 84% and 82% respectively.
The team reported that 10% of patients died after a median survival time of 32 months.
Of the patients that died, 2 developed organ dysfunction owing to recurrence of primary biliary cirrhosis.
Histological recurrence was found in 14% of patients after a median time of 61 months.
The team observed that patients with tacrolimus immunosuppression developed primary biliary cirrhosis recurrence more often, and also earlier.
The research team identified 57 patients that developed an acute rejection, and 2 patients with a chronic rejection episode.
Liver function did not alter within the first 5 years after histologically proven primary biliary cirrhosis recurrence.
Dr Jacoba's team concluded, “Multivariate analysis of the investigated patients showed that the recipient's age and tacrolimus immunosuppression were significant risk factors for primary biliary cirrhosis recurrence.”
“Long-term follow-up of up to 15 years after liver transplantation, owing to primary biliary cirrhosis, in addition to maintenance of liver function, shows excellent organ and patient survival rates.”
“Although protocol liver biopsies revealed histological recurrence in 14% patients, only 2 patients developed graft dysfunction.”
“Tacrolimus-treated patients showed more frequently and also earlier histologically proven primary biliary cirrhosis recurrence.”
“However, in our population we could not observe an impact on graft dysfunction and patient's survival.”