Division of Digestive and Liver DiseasesDepartment of Internal MedicineThe University of Texas Southwestern Medical CenterDallasTX.
Department of Internal MedicineThe University of Texas Southwestern Medical CenterDallasTX.
Liver Transpl. 2021 Jun;27(6):866-875. doi: 10.1002/lt.25935.
After liver transplantation (LT), the role of ursodeoxycholic acid (UDCA) is not well characterized. We examine the effect of UDCA after LT in the prophylaxis of biliary complications (BCs) in all-comers for LT and the prevention of recurrent primary biliary cholangitis (rPBC) in patients transplanted for PBC. Two authors searched PubMed/MEDLINE and Embase from January 1990 through December 2018 to identify all studies that evaluate the effectiveness of UDCA prophylaxis after LT for BCs in all LT recipients and rPBC after LT in patients transplanted for PBC. Odds ratios (ORs) were calculated for endpoints of the BC study. Pooled recurrence rates were calculated for rPBC. The study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A total of 15 studies were included, comprising 530 patients in the analysis for BCs and 1727 patients in the analysis for rPBC. UDCA was associated with decreased odds of BCs (OR, 0.70; 95% confidence interval [CI], 0.52-0.93; P = 0.01) and biliary stones and sludge (OR, 0.49; 95% CI, 0.24-0.77; P = 0.004). Prophylactic use of UDCA did not affect the odds of biliary stricture. For patients transplanted for PBC, the rate of rPBC was lower with the prophylactic use of UDCA (IR 16.7%; 95% CI, 0.114%-22.0%; I2 = 36.1%) compared with not using prophylactic UDCA (IR 23.1%; 95% CI, 16.9%-29.3%; I2 = 86.7%). UDCA after LT reduces the odds of BC and bile stones and sludge in all-comer LT recipients and reduces or delays the incidence of rPBC in patients transplanted for PBC. UDCA use after LT could be considered in all LT recipients to reduce the odds of BC and may be particularly beneficial for patients transplanted for PBC by reducing the incidence of rPBC.
肝移植（LT）后，熊去氧胆酸（UDCA）的作用尚不清楚。我们研究了 LT 后 UDCA 在预防 LT 所有患者的胆道并发症（BC）和预防 PBC 患者 LT 后复发性原发性胆汁性胆管炎（rPBC）中的作用。两位作者搜索了 1990 年 1 月至 2018 年 12 月的 PubMed/MEDLINE 和 Embase，以确定所有评估 LT 后 UDCA 预防 LT 所有患者 BC 和 PBC 患者 LT 后 rPBC 有效性的研究。计算了 BC 研究终点的比值比（OR）。对 rPBC 进行了汇总复发率的计算。该研究符合系统评价和荟萃分析的首选报告项目的规定。共有 15 项研究被纳入分析，其中包括 530 例患者的 BC 分析和 1727 例患者的 rPBC 分析。UDCA 与 BC（OR，0.70；95%置信区间[CI]，0.52-0.93；P=0.01）和胆道结石和淤泥（OR，0.49；95%CI，0.24-0.77；P=0.004）的发生几率降低相关。UDCA 的预防性使用并未影响胆道狭窄的发生几率。对于 PBC 患者，UDCA 的预防性使用使 rPBC 的发生率降低（IR 16.7%；95%CI，0.114%-22.0%；I2=36.1%），而不使用预防性 UDCA（IR 23.1%；95%CI，16.9%-29.3%；I2=86.7%）。LT 后 UDCA 降低了 LT 所有患者的 BC 和胆道结石和淤泥的发生几率，并降低或延迟了 PBC 患者的 rPBC 发生率。LT 后 UDCA 的使用可考虑用于所有 LT 患者，以降低 BC 的发生几率，并且通过降低 rPBC 的发生率，可能对 PBC 患者特别有益。
