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UDCA reduces risk for recurrent cirrhosis after liver transplantation

Liver transplant recipients treated with ursodeoxycholic acid had a lower risk for recurrent primary biliary cirrhosis, according to published findings in the Journal of Hepatology.

Researchers collected and analyzed data of 90 patients enrolled across five French and Swiss transplant centers between 1988 and 2010 who underwent liver transplant for primary biliary cirrhosis (PBC). Nineteen patients underwent preventive therapy with 10 mg/kg to 15 mg/kg ursodeoxycholic acid (UDCA) daily.

Each patient was followed for a minimum of 1 year after transplant; the mean follow-up was 11.7 ± 5.5 years.

Overall, PBC recurrence was found in 53% of patients, including recurrence rates of 27% at 5 years, 47% at 10 years and 61% at 15 years. The mean time to recurrence was 6.4 ± 5 years.

In patients treated with preventive UDCA, the recurrence rate for PBC was 11% at 5 years, 21% at 10 years and 40% at 15 years. In patients who did not undergo treatment with UDCA, the recurrence rate for PBC was 32% at 5 years, 53% at 10 years and 70% at 15 years. The median time to recurrence was longer in patients who received UDCA therapy vs. those who did not (6.5 years vs. 4.9 years), although this difference was not significant.

Multivariate analysis showed preventive UDCA treatment was the only factor affecting the risk for recurrence (HR = 0.32; 95% CI, 0.11-0.91), after adjusting for potential confounders and risk factors.

The overall survival rate was 98% at 5 years, 94% at 10 years and 75% at 15 years. Recurrence and preventive UDCA treatment did not impact survival. However, seven patients with recurrent PBC developed graft cirrhosis, of which one required re-transplantation at 17 years. A second patient with recurrent PBC had to undergo re-transplantation due to fulminant acute hepatitis 15 years after transplant. The origin of the hepatitis is unknown in this patient.

“Given the extremely limited feasibility of prospective studies and the good tolerance and acceptability of long-term UDCA therapy, these results support the extended use of UDCA as a prophylaxis for PBC recurrence after [liver transplantation],” the investigators concluded. – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.