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Factors Associated With #Recurrence of Primary Biliary #Cholangitis After Liver Transplantation and Effects on Graft and Patient Survival
https://www.gastrojournal.org/article/S0016-5085(18)35089-3/fulltext
PBC recurred in 22% of patients after 5 years and 36% after 10 years. Age at diagnosis <50 years (hazard ratio HR, 1.79; 95% CI, 1.36–2.36; P < .001), age at liver transplantation <60 years (HR, 1.39; 95% CI, 1.02–1.90; P = .04), use of tacrolimus (HR, 2.31; 95% CI, 1.72–3.10; P < .001), and biochemical markers of severe cholestasis (bilirubin ≥100 μmol or alkaline phosphatase >3-fold the upper limit of normal) at 6 months after liver transplantation (HR, 1.79; 95% CI, 1.16–2.76; P = .008) were associated with higher risk of PBC recurrence, whereas use of cyclosporine reduced risk of PBC recurrence (HR, 0.62; 95% CI, 0.46–0.82; P = .001). In multivariable Cox regression with time-dependent covariate, recurrence of PBC significantly associated with graft loss (HR, 2.01; 95% CI, 1.16–3.51; P = .01) and death (HR, 1.72; 95% CI, 1.11–2.65; P = .02).
Conclusions
Younger age at the time of diagnosis with PBC or at liver transplantation, tacrolimus use, and biochemical markers of cholestasis after liver transplantation are associated with PBC recurrence. PBC recurrence reduces odds of graft and patient survival. Strategies are needed to prevent PBC recurrence or reduce its negative effects.
Factors Associated With #Recurrence of Primary Biliary #Cholangitis After Liver Transplantation and Effects on Graft and Patient Survival
https://www.gastrojournal.org/article/S0016-5085(18)35089-3/fulltext
PBC recurred in 22% of patients after 5 years and 36% after 10 years. Age at diagnosis <50 years (hazard ratio HR, 1.79; 95% CI, 1.36–2.36; P < .001), age at liver transplantation <60 years (HR, 1.39; 95% CI, 1.02–1.90; P = .04), use of tacrolimus (HR, 2.31; 95% CI, 1.72–3.10; P < .001), and biochemical markers of severe cholestasis (bilirubin ≥100 μmol or alkaline phosphatase >3-fold the upper limit of normal) at 6 months after liver transplantation (HR, 1.79; 95% CI, 1.16–2.76; P = .008) were associated with higher risk of PBC recurrence, whereas use of cyclosporine reduced risk of PBC recurrence (HR, 0.62; 95% CI, 0.46–0.82; P = .001). In multivariable Cox regression with time-dependent covariate, recurrence of PBC significantly associated with graft loss (HR, 2.01; 95% CI, 1.16–3.51; P = .01) and death (HR, 1.72; 95% CI, 1.11–2.65; P = .02).
Conclusions
Younger age at the time of diagnosis with PBC or at liver transplantation, tacrolimus use, and biochemical markers of cholestasis after liver transplantation are associated with PBC recurrence. PBC recurrence reduces odds of graft and patient survival. Strategies are needed to prevent PBC recurrence or reduce its negative effects.