Liver transplantation in primary biliary cirrhosis: Risk assessment and 11-year follow-up

Background/Aims: Liver transplantation (LTx) is the only established treatm ent in patients with end-stage primary biliary cirrhosis (PBC). Although sh ort-term survival after LTx in this group of patients is usually good, few data exist on the long-term survival. The optimal timing of transplantation is difficult. Thus, the aims of this study were to assess the long-term su rvival of patients with PBC after LTx and to identify potential predictive factors for a positive outcome. Methods: Survival of 28 patients with PBC w ho underwent LTx between 1985 and July 1999 in a single center was studied by Kaplan-Meier analysis and was compared to predicted survival without LTx using established prognostic models for PBC, the Mayo and European risk sc ores. Potential prognostic parameters obtained before LTx were tested for c orrelation to survival. Rates of bone fractures as markers of hepatic osteo dystrophy were compared before and after LTx. Results: Median follow-up aft er LTx was 90 months with a maximum of 140 months. Actuarial survival of pa tients with PBC was 89% after 1, 5, and 10 years and was significantly bett er than estimated survival without LTx after 1-7 years as calculated by the Mayo and European risk scores. Of several parameters tested, only serum bi lirubin and the prognostic scores, but no other liver function tests obtain ed immediately prior to transplantation were significantly correlated with survival after LTx. The duration of intensive care after LTx was not associ ated with any parameters obtained before LTx. Bone fractures were diagnosed in 43% of patients of whom the vast majority were osteopenic before LTx as determined by osteodensitometry. Conclusion: Longterm survival of a well-d efined group of patients with PBC was excellent after LTx and was inversely correlated with preoperative serum bilirubin levels as well as Mayo and Eu ropean risk scores. Copyright (C) 2000 S. Karger AG. Basel.