PBC-Transplantation and disease recurrence

Publication date: Available online 11 September 2018Source: Best Practice & Research Clinical GastroenterologyAuthor(s): Frederik NevensAbstractDespite near universal use of ursodeoxycholic acid (UDCA)-treated patients several patients still progress to liver transplant (LT) or death. Pruritus and fatigue are the most common symptoms. Liver transplantation for pruritus is highly effective but fatigue will not disappear in the majority of the patients. In contrast to other liver diseases, portal hypertension may develop in pre-cirrhotic patients with PBC. Patients with PBC have an incidence rate of 3.4 hepatocellular carcinoma cases for every 1,000 patient-years and risk factors are advanced stage of the disease and male sex. For the appropriate timing of LT the utility of prognostic models (bilirubin, Mayo risk score and MELD, in particular) and standard exception points in case of HCC are established. However, recent data from different part of the world demonstrated that PBC patients compared to patients with PSC have higher waiting-list mortality. Hyperlipidemia can be present in up to 80% of the patients but there is no evidence for an elevated cardiovascular risk, certainly not in relationship with LT. Patients transplanted for PBC suffer more frequently from acute cellular and also late cellular rejection. However, 5-year patient survival rates after LT of 80–85% is better than for most other indications . Recurrent PBC is reported in a range from 14 % up to 42% after...
Source: Best Practice and Research Clinical Gastroenterology - Category: Gastroenterology Source Type: research