TY - JOUR
T1 - Preventive administration of UDCA after liver transplantation for primary biliary cirrhosis is associated with a lower risk of disease recurrence
AU - Bosch, Alexie
AU - Dumortier, Jérôme
AU - Maucort-Boulch, Delphine
AU - Scoazec, Jean Yves
AU - Wendum, Dominique
AU - Conti, Filomena
AU - Morard, Isabelle
AU - Rubbia-Brandt, Laura
AU - Terris, Benoit
AU - Radenne, Sylvie
AU - Abenavoli, Ludovico
AU - Poupon, Raoul
AU - Chazouillères, Olivier
AU - Calmus, Yvon
AU - Boillot, Olivier
AU - Giostra, Emiliano
AU - Corpechot, Christophe
PY - 2015/12/1
Y1 - 2015/12/1
N2 - Background & Aims Recurrence of primary biliary cirrhosis (PBC) after liver transplantation (LT) is not rare and can occasionally lead to severe graft dysfunction and retransplantation. Ursodeoxycholic acid (UDCA) is a safe and effective treatment for PBC. However, whether preventive administration of UDCA after LT could lower the incidence of PBC recurrence is unknown. Methods Patients transplanted for PBC in five French and Swiss centers from 1988 to 2010 were included. Most patients from a single center received UDCA (10-15 mg/kg/d) preventively. Recurrence of PBC was histologically defined from biopsies routinely performed at 1, 5, 10, and 15 years of follow-up, and at any time when clinically indicated. Results A total of 90 patients with a 1-year minimum follow-up were studied retrospectively, including 19 (21%) patients receiving preventive UDCA. The mean follow-up was 12 years. Recurrence was diagnosed in 48 (53%) patients. The recurrence rates at 5, 10, and 15 years were 27%, 47%, and 61%, respectively. In a multivariate proportional hazards model adjusted for potential confounders and risk factors, preventive UDCA was the only factor affecting the risk of recurrence significantly (HR = 0.32; 95% CI: 0.11-0.91). The 5, 10, and 15-year rates of recurrence were 11%, 21%, and 40%, respectively, under preventive UDCA, and 32%, 53%, and 70%, respectively, without preventive UDCA. Seven patients with recurrence (15%) progressed to cirrhosis, requiring retransplantation in one. However, neither recurrence nor preventive UDCA had a significant impact on survival. Conclusions Preventive treatment with UDCA reduces the risk of PBC recurrence after LT.
AB - Background & Aims Recurrence of primary biliary cirrhosis (PBC) after liver transplantation (LT) is not rare and can occasionally lead to severe graft dysfunction and retransplantation. Ursodeoxycholic acid (UDCA) is a safe and effective treatment for PBC. However, whether preventive administration of UDCA after LT could lower the incidence of PBC recurrence is unknown. Methods Patients transplanted for PBC in five French and Swiss centers from 1988 to 2010 were included. Most patients from a single center received UDCA (10-15 mg/kg/d) preventively. Recurrence of PBC was histologically defined from biopsies routinely performed at 1, 5, 10, and 15 years of follow-up, and at any time when clinically indicated. Results A total of 90 patients with a 1-year minimum follow-up were studied retrospectively, including 19 (21%) patients receiving preventive UDCA. The mean follow-up was 12 years. Recurrence was diagnosed in 48 (53%) patients. The recurrence rates at 5, 10, and 15 years were 27%, 47%, and 61%, respectively. In a multivariate proportional hazards model adjusted for potential confounders and risk factors, preventive UDCA was the only factor affecting the risk of recurrence significantly (HR = 0.32; 95% CI: 0.11-0.91). The 5, 10, and 15-year rates of recurrence were 11%, 21%, and 40%, respectively, under preventive UDCA, and 32%, 53%, and 70%, respectively, without preventive UDCA. Seven patients with recurrence (15%) progressed to cirrhosis, requiring retransplantation in one. However, neither recurrence nor preventive UDCA had a significant impact on survival. Conclusions Preventive treatment with UDCA reduces the risk of PBC recurrence after LT.
KW - Calcineurin inhibitor
KW - Immunosuppression
KW - Liver biopsy
KW - Prophylaxis
KW - Risk factors
KW - Survival
KW - UDCA
UR - http://www.scopus.com/inward/record.url?scp=84983196451&partnerID=8YFLogxK
U2 - 10.1016/j.jhep.2015.07.038
DO - 10.1016/j.jhep.2015.07.038
M3 - Article
C2 - 26282232
AN - SCOPUS:84983196451
SN - 0168-8278
VL - 63
SP - 1449
EP - 1458
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 6
ER -