Benefit of transplantation in primary biliary cirrhosis between 1985-1997

Abstract

Background: In the 1980s, primary biliary cirrhosis (PBC) patients were shown to benefit from transplantation when compared to a mathematical model. This study, using the same model, evaluates a cohort of patients who underwent transplantation in the late 1980s and early 1990s before and after the introduction of therapy with ursodeoxycholic acid (UDCA).

Methods: All 73 PBC patients transplanted at the University of Toronto between 1985 and 1997 were included in the study. Actual survival posttransplantation, calculated with the Kaplan-Meier product-limit estimator, was compared to predicted survival without transplantation, as determined by the Mayo model. The effect of UDCA therapy on outcome was studied by dividing the cohort into those transplanted before and after 1992, the year in which UDCA use for PBC was introduced.

Results: At 2 years posttransplant, predicted survival without transplant was 55% whereas actual survival was 79%. At 7 years posttransplant, these figures were 22% and 68%, respectively (P=3 x 10(-8)). There was a nonsignificant trend towards improved survival in those transplanted during the UDCA era compared to those transplanted in the pre-UDCA era.

Conclusions: Liver transplantation remains extremely beneficial for patients with end-stage PBC. There was no difference in outcome after liver transplantation in those transplanted during the UDCA era when compared to their pre-UDCA counterparts.