HISTOLOGICAL EVIDENCE FOR RECURRENCE OF PRIMARY BILIARY-CIRRHOSIS AFTER LIVER-TRANSPLANTATION

Whether primary biliary cirrhosis recurs after orthotopic liver transp lantation remains a controversial issue. Sixty consecutive patients wi th primary biliary cirrhosis with at least 1 yr of follow-up after liv er transplantation were studied. All patients were treated with triple -drug immunosuppression (cyclosporine, prednisone, azathioprine). Hepa tic biochemical parameters and protocol liver biopsy specimens were ev aluated 1 wk, 3 wk, 4 mo and yearly after orthotopic liver transplanta tion and at times of liver dysfunction. Antimitochondrial antibody tit ers and IgM levels were determined at 4 mo and yearly. At the time of last follow-up, all patients had marked symptomatic improvement compar ed with their pretransplant condition, and 91% of the patients had nor mal hepatic biochemical parameters, including serum levels of alkaline phosphatase, bilirubin, ALT and IgM. In addition, all patients had si gnificant decreases in antimitochondrial antibody titer (p = 0.0001) a nd significant decreases in serum levels of IgM (p = 0.0001). Forty-on e of the 60 patients had near-normal liver histological appearance. Of those with abnormal histological appearance, five patients, 2 to 6 yr after orthotopic liver transplantation, had histological features typ ical of a florid duct lesion, suggesting recurrent primary biliary cir rhosis. All five patients with portal granulomas had normal hepatic bi ochemical values and were clinically asymptomatic. Two of the five pat ients had persistent antimitochondrial antibody titers. We consider th e documented histological changes highly suggestive of recurrence of p rimary biliary cirrhosis after liver transplantation but, so far, have no evidence that the condition in these patients is progressiVe.