Long-term survival and impact of ursodeoxycholic acid treatment for recurrent primary biliary cirrhosis after liver transplantation
Long-term survival and impact of ursodeoxycholic acid treatment for recurrent primary biliary cirrhosis after liver transplantation
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DOI：
10.1002/lt.21124
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发表时间：
2007-09-01
影响因子：
4.6
通讯作者：
Wiesner, Russell H.
中科院分区：
文献类型：
--
作者：
Charatcharoenwitthaya, Phunchai;Pimentel, Sylvania;Wiesner, Russell H.
肝移植术后原发性胆汁性肝硬化（PBC）的复发可能影响患者和移植物的长期随访生存。熊去氧胆酸（UDCA）治疗肝移植（LT）后复发性PBC的疗效仍不太清楚。本研究的目的如下：1）确定接受LT的PBC患者中复发性PBC对总生存期的意义，2）确定复发性PBC患者LT后UDCA治疗的疗效。对154例PBC患者进行了回顾性队列研究，这些患者在1985年至2005年接受了移植后至少随访1年的LT。共确定了52例复发性PBC患者。校正年龄和性别后，复发性PBC与死亡或再次肝移植无关（风险比，0.97，95%可信区间，0.41 - 2.31; P = 0.9）。共有38例复发性PBC患者接受UDCA治疗，平均剂量为12 mg/kg/天，平均持续时间为55个月。在36个月期间，估计52%的UDCA治疗患者的血清碱性磷酸酶和丙氨酸氨基转移酶正常化，而未治疗患者的这一比例为22%。亚组之间的组织学进展率无显著差异。UDCA不影响患者和移植物存活。总之，复发性PBC的发展对长期生存或再次移植的需要几乎没有影响。虽然UDCA治疗与生化改善相关，但其在延迟组织学进展方面的作用仍不清楚。在这一短期治疗中，与未经治疗的患者相比，UDCA与患者和移植物存活率的改善无关。
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.