| Background:Primary biliary cholangitis(PBC)is a chronic non-suppurative inflammation of the intrahepatic interlobular bile duct,which gradually progresses to fibrosis,cirrhosis,and ultimately,liver failure.Ursodeoxycholic acid(UDCA)is effective in improving liver function,slows the progression of liver fibrosis as the first-line medication for PBC.But about 40% of patients do not adequately respond to UDCA monotherapy.However,approximately 50% of patients who had poor or intolerable effects of UDCA are effective with the second-line treatment drug obeticholic acid(OCA).Therefore,to date,liver transplantation is the most effective treatment for patients with advanced PBC.The factors affecting the prognosis of the patients who underwent liver transplantation for PBC are not yet defined.Objective:This study retrospectively analyzed the 69 patients who underwent liver transplantation for PBC at two transplant centers,to clarify the changes in liver function of PBC patients at different time points after transplantation,and to analyze recurrence,complications and prognosis during follow-up.Methods:The enrolled patients were 69 patients who underwent liver transplantation for PBC from March 2006 to July 2018 in the First Hospital of Jilin University and the First Central Hospitalh of Tianjin.Collect the patient’s general information and preoperative laboratory and examination results,closely monitor the liver function changes within 4 weeks posttransplant,liver biopsy was performed when patients had unexplainable abnormal liver function during follow-up,and regular follow-up after discharge from the hospital to monitor the patient’s complications.Statistical analysis was performed using SPSS 25.0 software.Continuous variables obeyed normal distribution were presented as mean ± standard deviation,continuous variables of nonnormal distribution were expressed by median(minimum–maximum);and counts and percentages for categorical variables.Categorical variables were analyzed using the chi-square test,Fisher’s exact test and the log-rank test.The hazard ratio and 95%confidence interval were calculated by multivariate Cox regression analysis.The cumulative rates of survival and recurrence were estimated according to the KaplanMeier method.Results:1.The overall clinical characteristics of patients undergoing liver transplantation for PBC: the majority of patients undergoing liver transplantation were middle-aged women,the median age was 55 years(range,39–67),and 60 patients(87%)were female.The median end-stage liver disease score(MELD)and the aspartate aminotransferase-to-platelet ratio index(APRI)were 19(range,6–31)and 2.26(range,0.11–42.22),respectively.The median updated Mayo risk score was 9.53(range,4.34–12.44).There were 26 patients(37.7%)classified as Child-Pugh grade B and 43patients(62.3%)of grade C.2.The cumulative survival rates of PBC patients was 98.6% at 1 year,95.6% at 2years,and 95.6% at 3 years after transplantation(Log-rank P=0.006).3.The cumulative relapse rate of PBC patinets was 3.0% at 1 year,4.6% at 2 years,and 6.3% at 3 years after transplantation.Recurrence was correlated with recipient age at the time of transplantation,with recipient age less than 48 years being an independent risk factor for postoperative recurrence(Log-rank P<0.001).4.The level of AST and ALT increased sharply and peaked on the first postoperative day,and then decreased rapidly on the second day(AST declined more than ALT),returning to near normal values 1 week after surgery,and completely decreased to normal levels and maintained within 4 weeks after surgery.The level of ALP and GGT decreased to near normal values on the first postoperative day,but then slowly increased and reached a peak at the first week,and then gradually decreased to normal levels by 4 weeks.The overall changes of TBIL and DBIL showed an downward trend after transplantation,started to decrease on the first day and decreased to normal by 4 weeks after transplantation.Albumin(ALB)fluctuated upward and eventually increased to normal by 4 weeks posttransplant.In conclusion,all liver function indicators(including AST,ALT,ALP,GGT,TBIL,DBIL,ALB)of the patients recovered to normal values within 4 weeks after liver transplantation.5.There were kinds of complications after transplantation,including infection complications,biliary complications,vascular complications,rejection reactions and other complications.Posttransplant infections and biliary tract complications were the most common complications,with incidences of 62% and 26%,respectively.Conclusion:1.The patients who have performed liver transplantation patients for PBC have a long survival period,and APRI>2 was associated with a lower survival rate,so APRI could be considered for preliminary prediction of postoperative survival.2.Although UDCA was routinely used after transplantation,the incidence of recurrence gradually increased with the extension of follow-up time after transplantation,and the recurrence was correlated with age,with the recipient’s age younger than 48 years being associated with a higher risk for recurrent.3.Although various indexes of liver function have changed significantly in the early stage after liver transplantation,and completely recovered to the normal range within 4 weeks post-transplantation.4.There were many kinds of complications after liver transplantation.Infection and biliary ducts complications were the most complications after liver transplantation. |
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