Effect of pretransplantation ursodeoxycholic acid therapy on the outcome of liver transplantation in patients with primary biliary cirrhosis

As ursodeoxycholic acid (UDCA) delays the need for transplantation, this co uld result in patients with more comorbid disease, therefore more likely to have a worse outcome posttransplantation. The aim of this study is to comp are posttransplantation outcome in patients who received UDCA versus placeb o who subsequently required a liver transplant. Data on all trial patients referred for transplantation were retrospectively collected from three rand omized controlled trials of UDCA in patients with primary biliary cirrhosis (PBC), An intent-to-treat analysis was conducted with patients assigned to their original treatment allocation. UDCA and placebo groups were compared at trial entry, transplant referral, just before transplantation, and 1 mo nth and 1 year posttransplantation, From 1987 to 1996, 37 UDCA-treated and 53 placebo patients were referred for transplantation; their age, sex, and serum bilirubin levels were similar at study entry, Immediately before tran splantation, these two groups were again similar with respect to age, bilir ubin revel, Mayo risk score, and serum creatinine level, Posttransplantatio n survival rates at 1 month were 93.9% in the UDCA group and 88.4% in the p lacebo group, and 1 year survival rates were 90.3% and 78.4%, respectively (not significant). Posttransplantation, the two groups had similar rates of infection (53.9% v58%); however, rejection occurred significantly less oft en in the UDCA group; 42.9% versus 68.8% in the placebo group (P = 0.4), Th e posttransplantation outcome of UDCA-treated patients with PBC is no diffe rent from those who were administered placebo, There is no evidence to sugg est the beneficial effect of UDCA in delaying the need for transplantation is associated with a worse outcome once liver transplantation becomes neces sary. Copyright (C) 1999 by the American Association for the Study of Liver Diseases.