Long-term outcomes of patients undergoing liver transplantation for primary biliary cholangitis

Introduction: Primary biliary cholangitis (PCa) is a disease characterized by chronic cholestasis, circulating anti-mitochondrial antibodies (AMA), non-suppurative cholangitis and liver biopsy findings of interlobular bile duct injury. Liver transplantation is the definitive treatment for advanced disease in patients with PCa and the 10-year survival rate after transplantation is approximately 70%. The aim of this study was to investigate the long-term outcome of patients who underwent liver transplantation. Materials and Methods: The study included adult patients who underwent liver transplantation for primary biliary cholangitis at Inonu University Liver Transplant Institute between January 2004 and December 2023. Clinical data were retrospectively analyzed for age, gender, type of transplantation, AMA level before and after transplantation, presence of hyperlipidemia, osteoporosis, indication for transplantation, age, gender, blood type of the donor, consanguinity between the donor and the recipient, presence of hepatocellular carcinoma before and after transplantation, immunosuppressive therapy used after transplantation, ursodeoxycholic acid (UDCA) or steroid use status after transplantation, survival rates of the patient after transplantation, cause of death in patients who died after transplantation, portal vein thrombosis, hepatic vein thrombosis, hepatic artery thrombosis after transplantation, duration if any, recurrence and rejection development after transplantation, ıtching status after transplantation, alp level, cholangiocellular cancer after transplantation, second and third n. Results: A total of 29 patients, 6 (20.7%) males and 23 (79.3%) females, were included in the study. The mean age of the patients was 58.7±10.5 years. The 12-month, 36-month, 60-month and 120-month survival rates were 91.7%, 75%, 68.8% and 57.3%, respectively. Of the transplants, 2 (6.9%) were cadaveric and 27 (93.1%) were from living donors. Recurrence rate was 17.2%, rejection rate was 17.2% and biliary complication rate was 17.2%. A total of 7 patients (24.1%) had vascular complications, including portal vein thrombosis in 5 patients and hepatic artery thrombosis in 2 patients. When the factors affecting the post-transplant mortality rate were analyzed, only the use of non-immunosuppressive corticosteroids and UDCA treatment had a significant effect. Discussion: Our results suggest that liver transplantation is a highly promising treatment in end-stage PCa patients with no other treatment options and that post-transplant non-immunosuppressive corticosteroid and UDCA treatment is extremely vital and important in this patient group. Keywords: Primary biliary cholangitis, Liver transplantation