Transplantation for primary biliary cirrhosis: Retrospective analysis of 400 patients in a single center

Orthotopic liver transplantation (OLT) is an effective treatment for patien ts with advanced primary biliary cirrhosis (PBC), We have conducted a retro spective analysis of 400 consecutive patients transplanted for PBC between 1983 and 1999, Mean follow-up was 56 months. The proportion of patients gra fted for PBC fell progressively, from 35% in 1990 (n = 80) to 21% in 1999 ( n = 111); comparison of patients grafted in the 2 decades showed that the m edian age increased from 53 to 56 years and the median serum bilirubin at t ransplantation fell from 270 mu mol/L to 132 mu mol/L. The overall actuaria l patient and graft survival at 1, 5, and 10 years is 83%, 78%, and 67% and 82%, 75%, and 61%, respectively. The net gain in 5-year survival compared with predicted survival in the absence of transplantation fell from 37% (ra nge, 82%-90%) to 16% (range, 91%-99%). Multiple organ failure (16.1%) and s epsis (9.6%) were the major causes of early deaths (<6 months). Recurrent P BC, diagnosed on allograft histology, was found in 68 (17%) patients, at a mean time of 36 months. We were unable to identify any pretransplantation d onor or recipient factor, which identified those patients at risk of recurr ence, although recurrence was much earlier and more frequently seen in pati ents receiving tacrolimus (P =.04), PBC remains a good indication for liver transplantation, with excellent survival rates. The age at transplantation increased although patients tended to be grafted earlier. Survival rates h ave increased although there is a reduction in the survival benefit, Recurr ence may be common, but does not seem to affect medium-term graft survival.