Liver transplants for primary biliary cholangitis (PBC) have declined since ursodeoxycholic acid (UDCA) became widely used1

Since 1988, PBC has been the second leading cause of liver transplant in women in the United States, behind hepatitis C2


Approximately 20% to 25% of patients with PBC who undergo liver transplant develop recurrent disease within 10 years.3,4

  • Recurrent PBC does not usually affect long-term patient or graft survival3,5
  • Long-term immunosuppression with a cyclosporine-based regimen may be associated with reduced incidence of recurrent PBC5,6
  • Risk factors for accelerated recurrent PBC include tacrolimus therapy and advanced donor age4-6
  • Osteopenia may worsen for the first 6 months after transplant7
    • However, bone mineral density will return to baseline after 12 months7

Avoiding liver transplant

  • Two out of 5 patients do not respond to UDCA and may need additional medical therapy and/or liver transplant8
  • For many patients treated with UDCA, transplant-free survival is significantly lower in patients with suboptimal biochemical response8,9

References:  1. Lee J, Belanger A, Doucette JT, Stanca C, Friedman S, Bach N. Transplantation trends in primary biliary cirrhosis. Clin Gastroenterol Hepatol. 2007;5(11):1313-1315. doi:10.1016/j.cgh.2007.07.015.  2. Organ Procurement and Transplantation Network. US Health Resources and Services Administration website. http://optn.transplant.hrsa.gov/converge/latestData/rptData.asp. Updated May 22, 2015. Accessed August 20, 2015.  3. Sylvestre PB, Batts KP, Burgart LJ, Poterucha JJ, Wiesner RH. Recurrence of primary biliary cirrhosis after liver transplantation: histologic estimate of incidence and natural history. Liver Transpl. 2003;9(10):1086-1093. doi:10.1053/jlts.2003.50213.  4. Lindor KD, Gershwin ME, Poupon R, Kaplan M, Bergasa NV, Heathcote EJ. Primary biliary cirrhosis. Hepatology. 2009;50(1):291-308. doi:10.1002/hep.22906. (AASLD guidelines)  5. Charatcharoenwitthaya P, Pimentel S, Talwalkar JA, et al. Long-term survival and impact of ursodeoxycholic acid treatment for recurrent primary biliary cirrhosis after liver transplantation. Liver Transpl. 2007;13(9):1236-1245. doi:10.1002/lt.21124.  6. Neuberger J, Gunson B, Hubscher S, Nightingale P. Immunosuppression affects the rate of recurrent primary biliary cirrhosis after liver transplantation. Liver Transpl. 2004;10(4):488-491. doi:10.1002/lt.20123.  7. Eastell R, Dickson ER, Hodgson SF, et al. Rates of vertebral bone loss before and after liver transplantation in women with primary biliary cirrhosis. Hepatology. 1991;14(2):296-300. doi:10.1002/hep.1840140215.  8. Parés A, Caballería L, Rodés J. Excellent long-term survival in patients with primary biliary cirrhosis and biochemical response to ursodeoxycholic acid. Gastroenterology. 2006;130(3):715-720. doi:10.1053/j.gastro.2005.12.029.  9. Corpechot C, Abenavoli L, Rabahi N, et al. Biochemical response to ursodeoxycholic acid and long-term prognosis in primary biliary cirrhosis. Hepatology. 2008;48(3):871-877. doi:10.1002/hep.22428.