Charatcharoenwitthaya Phunchai, Pimentel Sylvania, Talwalkar Jayant A, Enders Felicity T, Lindor Keith D, Krom Ruud A F, Wiesner Russell H
Miles and Shirley Fitterman Center for Digestive Diseases, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
Liver Transpl. 2007 Sep;13(9):1236-45. doi: 10.1002/lt.21124.
The recurrence of primary biliary cirrhosis (PBC) in the hepatic allograft may impact patient and graft survival with long-term follow-up. The efficacy of ursodeoxycholic acid (UDCA) for treatment of recurrent PBC after liver transplantation (LT) remains less well known. The aims of this study were as follows: 1) to determine the significance of recurrent PBC on overall survival among PBC patients who underwent LT, and 2) to determine the efficacy of UDCA treatment after LT in patients with recurrent PBC. A retrospective cohort study was conducted of 154 PBC patients who underwent LT with at least 1 yr of follow-up after transplantation from 1985 through 2005. A total of 52 patients with recurrent PBC were identified. After adjusting for age and gender, recurrent PBC was not associated with death or liver retransplantation (hazard ratio, 0.97, 95% confidence interval, 0.41-2.31; P = 0.9). A total of 38 patients with recurrent PBC received UDCA at an average dose of 12 mg/kg/day for a mean duration of 55 months. Over a 36-month period, an estimated 52% of UDCA-treated patients experienced normalization of serum alkaline phosphatase and alanine aminotransferase compared to 22% of untreated patients. There was no significant difference in the rate of histological progression between subgroups. UDCA did not influence patient and graft survival. In conclusion, the development of recurrent PBC has little impact on long-term survival or need for retransplantation. While UDCA therapy is associated with biochemical improvement, its role in delaying histologic progression remains unknown. In this short period of treatment, UDCA was not associated with improved patient and graft survival compared to untreated patients.
肝移植受者中，原发性胆汁性肝硬化（PBC）复发可能会影响患者和移植物的长期生存。熊去氧胆酸（UDCA）治疗肝移植（LT）后复发性PBC的疗效尚不明确。本研究旨在：1）确定复发性PBC对接受LT的PBC患者总体生存的影响；2）确定LT后UDCA治疗复发性PBC患者的疗效。对1985年至2005年间接受LT且移植后至少随访1年的154例PBC患者进行了一项回顾性队列研究。共识别出52例复发性PBC患者。在调整年龄和性别后，复发性PBC与死亡或再次肝移植无关（风险比，0.97；95%置信区间，0.41 - 2.31；P = 0.9）。共有38例复发性PBC患者接受了UDCA治疗，平均剂量为12 mg/kg/天，平均疗程为55个月。在36个月的时间里，估计52%接受UDCA治疗的患者血清碱性磷酸酶和丙氨酸转氨酶恢复正常，而未治疗患者的这一比例为22%。各亚组间组织学进展率无显著差异。UDCA不影响患者和移植物的生存。总之，复发性PBC的发生对长期生存或再次移植需求影响不大。虽然UDCA治疗与生化指标改善相关，但其在延缓组织学进展中的作用尚不清楚。在这段短期治疗中，与未治疗患者相比，UDCA并未改善患者和移植物的生存。
