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PBC recurrence after liver transplantation decreases survival rates

Primary biliary cholangitis recurrence after liver transplantation reduced the likelihood for graft and overall survival, according to a recently published study.

Younger patients and those with a history of tacrolimus use and cholestasis were more likely to experience PBC recurrence posttransplant.

“Prior reports have also suggested that the development of PBC recurrence has no significant impact on long-term patient survival or need for a second LT, and thus its clinical impact has been questioned,” Aldo J. Montano-Loza, PhD, from the University of Alberta, and colleagues wrote. “Our results imply that patients at higher risk of recurrence of PBC should be considered for therapeutic strategies within the first year of LT to prevent occurrence of PBC recurrence.”

The study comprised 785 patients with PBC who underwent liver transplantation. During a median period of 4.4 years, 31% of the study cohort experienced PBC recurrence.

Multivariate analysis showed that age at transplantation (HR = 0.98; 95% CI, 0.97-0.99), tacrolimus use (HR = 3.41; 95% CI, 1.42-8.15), mycophenolate use (HR = 1.46; 95% CI, 1.03-2.08), and severe biochemical cholestasis at 6 months (HR = 1.98; 95% CI, 1.28-3.06) independently correlated with PBC recurrence.

These factors remained significantly associated with recurrence at 12 months and mild cholestasis reached significance (HR = 2.26; 95% CI, 1.52-3.36).

PBC recurrence also correlated significantly with graft failure (time-dependent HR = 2.01; 95% CI, 1.16-3.51). Both age at transplantation (HR = 1.06; 95% CI, 1.02-1.1) and recurrence (HR = 1.72; 95% CI, 1.11-2.65) correlated with overall survival. Overall survival was lower in patients with PBC recurrence compared with patients with no recurrence (15 vs. 19 years; P = .001).

“As preventative [ursodeoxycholic acid (UDCA)] commenced early after LT is associated with a decreased risk of recurrence of PBC, patients with biochemical features associated with higher risk of recurrence of PBC may subsequently benefit from early intervention of UDCA treatment as well,” Montano-Loza and colleagues wrote.

They noted, however, that the benefit of UDCA should be investigated in prospective studies along with evaluation of second line therapies, such as Ocaliva (obeticholic acid, Intercept) or bezafibrate to reduce the risk of graft loss related to PBC recurrence. – by Talitha Bennett

Disclosure: Montano-Loza has served on advisory boards for Intercept Pharmaceuticals. Please see the full study for the other authors’ relevant financial disclosures.