Abstract | BACKGROUND & AIMS:
Primary biliary cholangitis (PBC) frequently recurs after liver transplantation. We evaluated risk factors associated with recurrence of PBC and its effects on patient and graft survival in a multicenter, international cohort (the Global PBC Study Group). METHODS: We collected demographic and clinical data from 785 patients (89% female) with PBC who underwent liver transplantation (mean age, 54 ± 9 years) from February 1983 through June 2016, among 13 centers in North America and Europe. Results from biochemical tests performed within 12 months of liver transplantation were analyzed to determine whether markers of cholestasis could identify patients with recurrence of PBC (based on histologic analysis). Patients were followed for a median 6.9 years (interquartile range, 6.1-7.9 years). RESULTS: 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:
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Authors | Aldo J Montano-Loza, Bettina E Hansen, Christophe Corpechot, Davide Roccarina, Douglas Thorburn, Palak Trivedi, Gideon Hirschfield, Patrick McDowell, Raoul Poupon, Jerome Dumortier, Alexie Bosch, Emiliano Giostria, Filomena Conti, Albert Parés, Anna Reig, Annarosa Floreani, Francesco Paolo Russo, Jorn C Goet, Maren H Harms, Henk van Buuren, Natalie Van den Ende, Frederik Nevens, Xavier Verhelst, Maria Francesca Donato, Federica Malinverno, Maryam Ebadi, Andrew L Mason, Global PBC Study Group |
Journal | Gastroenterology
(Gastroenterology)
Vol. 156
Issue 1
Pg. 96-107.e1
(01 2019)
ISSN: 1528-0012 [Electronic] United States |
PMID | 30296431
(Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Biomarkers
- Immunosuppressive Agents
- Tacrolimus
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Topics |
- Age of Onset
- Biomarkers
(blood)
- Biopsy
- Europe
- Female
- Graft Survival
- Humans
- Immunosuppressive Agents
(adverse effects)
- Liver Cirrhosis, Biliary
(blood, diagnosis, mortality, surgery)
- Liver Transplantation
(adverse effects, mortality)
- Male
- Middle Aged
- North America
- Recurrence
- Risk Factors
- Tacrolimus
(adverse effects)
- Time Factors
- Treatment Outcome
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