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Factors associated with recurrence of primary biliary cholangitis after liver transplantation and effects on graft and patient survival

(2019) GASTROENTEROLOGY. 156(1). p.96-107
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Abstract
BACKGROUND & AIMS: Primary biliary cholangitis (PBC) frequently recurs after liver transplantation. We evaluated risk factors associated with recurrence of PBC and its effects on patient and graft survival in a multicenter, international cohort (the Global PBC Study Group). METHODS: We collected demographic and clinical data from 785 patients (89% female) with PBC who underwent liver transplantation (mean age, 54 +/- 9 years) from February 1983 through June 2016, among 13 centers in North America and Europe. Results from biochemical tests performed within 12 months of liver transplantation were analyzed to determine whether markers of cholestasis could identify patients with recurrence of PBC (based on histologic analysis). Patients were followed for a median 6.9 years (interquartile range, 6.1-7.9 years). RESULTS: PBC recurred in 22% of patients after 5 years and 36% after 10 years. Age at diagnosis<50 years (hazard ratio [HR], 1.79; 95% CI, 1.36-2.36; P<.001), age at liver transplantation <60 years (HR, 1.39; 95% CI, 1.02-1.90; P=04), use of tacrolimus (HR, 2.31; 95% CI, 1.72-3.10; P<.001), and biochemical markers of severe cholestasis (bilirubin -100 mmol or alkaline phosphatase > 3-fold the upper limit of normal) at 6 months after liver transplantation (HR, 1.79; 95% CI, 1.16-2.76; P=008) were associated with higher risk of PBC recurrence, whereas use of cyclosporine reduced risk of PBC recurrence (HR, 0.62; 95% CI, 0.46-0.82; P=001). In multivariable Cox regression with time-dependent covariate, recurrence of PBC significantly associated with graft loss (HR, 2.01; 95% CI, 1.16-3.51; P=01) and death (HR, 1.72; 95% CI, 1.11-2.65; P=02). CONCLUSIONS: Younger age at the time of diagnosis with PBC or at liver transplantation, tacrolimus use, and biochemical markers of cholestasis after liver transplantation are associated with PBC recurrence. PBC recurrence reduces odds of graft and patient survival. Strategies are needed to prevent PBC recurrence or reduce its negative effects.
Keywords
PLACEBO-CONTROLLED TRIAL, CHANGING NOMENCLATURE, AUTOIMMUNE HEPATITIS, DISEASE RECURRENCE, FOLLOW-UP, CIRRHOSIS, RISK, PBC, Cholestatic, Recurrent Disease, Re-Transplantation, Autoimmune Liver, Disease

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MLA
Montano-Loza, Aldo J., et al. “Factors Associated with Recurrence of Primary Biliary Cholangitis after Liver Transplantation and Effects on Graft and Patient Survival.” GASTROENTEROLOGY, vol. 156, no. 1, 2019, pp. 96–107, doi:10.1053/j.gastro.2018.10.001.
APA
Montano-Loza, A. J., Hansen, B. E., Corpechot, C., Roccarina, D., Thorburn, D., Trivedi, P., … Mason, A. L. (2019). Factors associated with recurrence of primary biliary cholangitis after liver transplantation and effects on graft and patient survival. GASTROENTEROLOGY, 156(1), 96–107. https://doi.org/10.1053/j.gastro.2018.10.001
Chicago author-date
Montano-Loza, Aldo J., Bettina E. Hansen, Christophe Corpechot, Davide Roccarina, Douglas Thorburn, Palak Trivedi, Gideon Hirschfield, et al. 2019. “Factors Associated with Recurrence of Primary Biliary Cholangitis after Liver Transplantation and Effects on Graft and Patient Survival.” GASTROENTEROLOGY 156 (1): 96–107. https://doi.org/10.1053/j.gastro.2018.10.001.
Chicago author-date (all authors)
Montano-Loza, Aldo J., Bettina E. Hansen, Christophe Corpechot, Davide Roccarina, Douglas Thorburn, Palak Trivedi, Gideon Hirschfield, Patrick McDowell, Raoul Poupon, Jerome Dumortier, Alexie Bosch, Emiliano Giostria, Filomena Conti, Albert Pares, Anna Reig, Annarosa Floreani, Francesco Paolo Russo, Jorn C. Goet, Maren H. Harms, Henk van Buuren, Natalie Van den Ende, Frederik Nevens, Xavier Verhelst, Maria Francesca Donato, Federica Malinverno, Maryam Ebadi, and Andrew L. Mason. 2019. “Factors Associated with Recurrence of Primary Biliary Cholangitis after Liver Transplantation and Effects on Graft and Patient Survival.” GASTROENTEROLOGY 156 (1): 96–107. doi:10.1053/j.gastro.2018.10.001.
Vancouver
1.
Montano-Loza AJ, Hansen BE, Corpechot C, Roccarina D, Thorburn D, Trivedi P, et al. Factors associated with recurrence of primary biliary cholangitis after liver transplantation and effects on graft and patient survival. GASTROENTEROLOGY. 2019;156(1):96–107.
IEEE
[1]
A. J. Montano-Loza et al., “Factors associated with recurrence of primary biliary cholangitis after liver transplantation and effects on graft and patient survival,” GASTROENTEROLOGY, vol. 156, no. 1, pp. 96–107, 2019.
@article{8653976,
  abstract     = {BACKGROUND & AIMS: Primary biliary cholangitis (PBC) frequently recurs after liver transplantation. We evaluated risk factors associated with recurrence of PBC and its effects on patient and graft survival in a multicenter, international cohort (the Global PBC Study Group). 
METHODS: We collected demographic and clinical data from 785 patients (89% female) with PBC who underwent liver transplantation (mean age, 54 +/- 9 years) from February 1983 through June 2016, among 13 centers in North America and Europe. Results from biochemical tests performed within 12 months of liver transplantation were analyzed to determine whether markers of cholestasis could identify patients with recurrence of PBC (based on histologic analysis). Patients were followed for a median 6.9 years (interquartile range, 6.1-7.9 years). 
RESULTS: PBC recurred in 22% of patients after 5 years and 36% after 10 years. Age at diagnosis<50 years (hazard ratio [HR], 1.79; 95% CI, 1.36-2.36; P<.001), age at liver transplantation <60 years (HR, 1.39; 95% CI, 1.02-1.90; P=04), use of tacrolimus (HR, 2.31; 95% CI, 1.72-3.10; P<.001), and biochemical markers of severe cholestasis (bilirubin -100 mmol or alkaline phosphatase > 3-fold the upper limit of normal) at 6 months after liver transplantation (HR, 1.79; 95% CI, 1.16-2.76; P=008) were associated with higher risk of PBC recurrence, whereas use of cyclosporine reduced risk of PBC recurrence (HR, 0.62; 95% CI, 0.46-0.82; P=001). In multivariable Cox regression with time-dependent covariate, recurrence of PBC significantly associated with graft loss (HR, 2.01; 95% CI, 1.16-3.51; P=01) and death (HR, 1.72; 95% CI, 1.11-2.65; P=02). 
CONCLUSIONS: Younger age at the time of diagnosis with PBC or at liver transplantation, tacrolimus use, and biochemical markers of cholestasis after liver transplantation are associated with PBC recurrence. PBC recurrence reduces odds of graft and patient survival. Strategies are needed to prevent PBC recurrence or reduce its negative effects.},
  author       = {Montano-Loza, Aldo J. and Hansen, Bettina E. and Corpechot, Christophe and Roccarina, Davide and Thorburn, Douglas and Trivedi, Palak and Hirschfield, Gideon and McDowell, Patrick and Poupon, Raoul and Dumortier, Jerome and Bosch, Alexie and Giostria, Emiliano and Conti, Filomena and Pares, Albert and Reig, Anna and Floreani, Annarosa and Russo, Francesco Paolo and Goet, Jorn C. and Harms, Maren H. and van Buuren, Henk and Van den Ende, Natalie and Nevens, Frederik and Verhelst, Xavier and Donato, Maria Francesca and Malinverno, Federica and Ebadi, Maryam and Mason, Andrew L.},
  issn         = {0016-5085},
  journal      = {GASTROENTEROLOGY},
  keywords     = {PLACEBO-CONTROLLED TRIAL,CHANGING NOMENCLATURE,AUTOIMMUNE HEPATITIS,DISEASE RECURRENCE,FOLLOW-UP,CIRRHOSIS,RISK,PBC,Cholestatic,Recurrent Disease,Re-Transplantation,Autoimmune Liver,Disease},
  language     = {eng},
  number       = {1},
  pages        = {96--107},
  title        = {Factors associated with recurrence of primary biliary cholangitis after liver transplantation and effects on graft and patient survival},
  url          = {http://dx.doi.org/10.1053/j.gastro.2018.10.001},
  volume       = {156},
  year         = {2019},
}

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