Long-term impact of preventive UDCA therapy after transplantation for primary biliary cholangitis.
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Corpechot Christophe, Chazouillères Olivier, Belnou Pierre, Montano-Loza Aldo J, Mason Andrew, Ebadi Maryam, Eurich Dennis, Chopra Sascha, Jacob Dietmar, Schramm Christoph, Sterneck Martina, Bruns Tony, Reuken Philipp, Rauchfuss Falk, Roccarina Davide, Thorburn Douglas, Gerussi Alessio, Trivedi Palak, Hirschfield Gideon, McDowell Patrick, Nevens Frederik, Boillot Olivier, Bosch Alexie, Giostra Emiliano, Conti Filomena, Poupon Raoul, Parés Albert, Reig Anna, Donato Maria Francesca, Malinverno Federica, Floreani Annarosa, Russo Francesco Paolo, Cazzagon Nora, Verhelst Xavier, Goet Jorn, Harms Maren, van Buuren Henk, Hansen Bettina, Carrat Fabrice, Dumortier Jérôme, Global PBC Study Group
Аннотация
METHODS: We performed a retrospective cohort study in 780 patients transplanted for PBC, between 1983-2017 in 16 centers (9 countries), and followed-up for a median of 11 years. Among them, 190 received preventive UDCA (10-15 mg/kg/day). The primary outcome was histological evidence of PBC recurrence. The secondary outcomes were graft loss, liver-related death, and all-cause death. The association between preventive UDCA and outcomes was quantified using multivariable-adjusted Cox and restricted mean survival time (RMST) models.
RESULTS: While recurrence of PBC significantly shortened graft and patient survival, preventive exposure to UDCA was associated with reduced risk of PBC recurrence (adjusted hazard ratio [aHR] 0.41; 95% CI 0.28-0.61; p <0.0001), graft loss (aHR 0.33; 95% CI 0.13-0.82; p <0.05), liver-related death (aHR 0.46; 95% CI 0.22-0.98; p <0.05), and all-cause death (aHR 0.69; 95% CI 0.49-0.96; p <0.05). On RMST analysis, preventive UDCA led to a survival gain of 2.26 years (95% CI 1.28-3.25) over a period of 20 years. Exposure to cyclosporine rather than tacrolimus had a complementary protective effect alongside preventive UDCA, reducing the cumulative incidence of PBC recurrence and all-cause death.
CONCLUSIONS: Preventive UDCA after LT for PBC is associated with a reduced risk of disease recurrence, graft loss, and death. A regimen combining cyclosporine and preventive UDCA is associated with the lowest risk of PBC recurrence and mortality.
LAY SUMMARY: Recurrence of primary biliary cholangitis after liver transplantation is frequent and can impair graft and patient survival. We performed the largest international study of transplanted patients with primary biliary cholangitis to date. Preventive administration of ursodeoxycholic acid after liver transplantation was associated with reduced risk of disease recurrence, graft loss, liver-related and all-cause mortality. A regimen combining cyclosporine and preventive ursodeoxycholic acid was associated with the best outcomes.