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. 2019 Feb;49(3):285-295.
doi: 10.1111/apt.15060. Epub 2018 Dec 18.

Trends in liver transplantation for primary biliary cholangitis in Europe over the past three decades

Maren H Harms  1 , Quisette P Janssen  1 , Rene Adam  2 , Christophe Duvoux  3 , Darius Mirza  4 , Ernest Hidalgo  5 , Christopher Watson  6 , Stephen J Wigmore  7 , Massimo Pinzani  8 , Helena Isoniemi  9 , Johann Pratschke  10 , Krzysztof Zieniewicz  11 , Jurgen L Klempnauer  12 , William Bennet  13 , Vincent Karam  2 , Henk R van Buuren  1 , Bettina E Hansen  1   14 , Herold J Metselaar  1 ; European Liver and Intestine Transplant Association (ELITA)
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Trends in liver transplantation for primary biliary cholangitis in Europe over the past three decades

Maren H Harms et al. Aliment Pharmacol Ther. 2019 Feb.

Abstract

Background: The importance of primary biliary cholangitis as an indication for liver transplantation has probably been influenced by the introduction of therapies, and changes in selection criteria and disease epidemiology.

Aims: To assess the time trends in liver transplantation for primary biliary cholangitis and to evaluate the characteristics of the patient population during the past three decades.

Methods: Patients undergoing liver transplantation from 1986 to 2015 in centres reporting to the European Liver Transplantation Registry were included. We excluded combined organ transplantations and patients <18 years. Trends were assessed using linear regression models.

Results: We included 112 874 patients, of whom 6029 (5.3%) had primary biliary cholangitis. After an initial increase in the first decade, the annual number of liver transplantation for primary biliary cholangitis remained stable at around 200. The proportion of liver transplantations for primary biliary cholangitis decreased from 20% in 1986 to 4% in 2015 (P < 0.001). Primary biliary cholangitis was the only indication showing a consistent proportional decrease throughout all decades. From the first to the third decade, the age at liver transplantation increased from 54 (IQR 47-59) to 56 years (IQR 48-62) and the proportion of males increased from 11% to 15% (both P < 0.001).

Conclusions: We have found a proportional decrease in primary biliary cholangitis as indication for liver transplantation. However, despite treatment with ursodeoxycholic acid and improved disease awareness, the absolute annual number of liver transplantations has stabilised.

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Figures

Figure 1
Figure 1
Annual absolute number of liver transplantations in ELTR centres from 1986‐2016 for (A) all primary disease aetiologies, and (B) PBC. ELTR, European Liver Transplant Registry; PBC, primary biliary cholangitis
Figure 2
Figure 2
Proportion of liver transplantations in ELTR centres from 1986 to 2016 for (A) PBC and (B) PBC and other leading indications. ELTR, European Liver Transplant Registry; PBC, primary biliary cholangitis
Figure 3
Figure 3
A, Age (median, interquartile range) at time of liver transplantation for PBC in Europe from 1986 to 2016, B, Proportional age distribution for transplanted PBC patients in Europe from 1986 to 2016. PBC, primary biliary cholangitis
Figure 4
Figure 4
Percentage of male vs female patients transplanted for PBC in Europe from 1986 to 2016. PBC, primary biliary cholangitis
Figure 5
Figure 5
A, MELD scores at time of transplantation for patients with PBC in Europe from 1996 to 2015; B, MELD scores of patients transplanted for PBC vs non‐PBC aetiologies in 1996‐2005 vs 2006‐2015. MELD scores are reported as median with their interquartile ranges. As a result of a lack of biochemical data from the first decade of the study period, data are shown for 1996‐2015. In this period, MELD scores were available for 2749 (46%) of patients with PBC and 51 410 (48%) of non‐PBC patients
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