The changing clinical presentation of recurrent primary biliary cirrhosis after liver transplantation

Edmund Q. Sanchez, Marlon F. Levy, Robert M. Goldstein, Carlos G. Fasola, Glenn W. Tillery, George J. Netto, David L. Watkins, Jeffrey S. Weinstein, Natalie G. Murray, Derek Byers, Laura L. Christensen, Goran B. Klintmalm

Research output: Contribution to journalArticle

Abstract

Background. Recurrent Disease After Liver Trans-Plant Is a significant problem. Recurrent primary biliary cirrhosis (RPBC) is a histologic diagnosis. Clinical data is unreliable in predicting or diagnosing recurrence. RPBC appears to have a changing clinical presentation in recent years. Materials and Methods. The diagnosis of RPBC after liver transplantation was made histologically. Data were obtained from our prospectively maintained liver-transplant database and evaluated statistically. Results. Between 1985 and 1999, 1,835 liver transplants were performed, 169 for PBC. One hundred fifty-six patients were evaluated (one patient received retransplantation, and 13 were excluded). Seventeen (10.9%) experienced recurrence. Median posttransplantation follow-up time was 72.1 months. Median time to recurrence was 49.6 months. Median follow-up time after recurrence was 11.5 months. Neither acute rejection episodes (P=0.34) nor OKT3 use (P=0.36) before diagnosis of recurrence was significant. The combination of cyclosporine, azathioprine, and prednisolone demonstrated recurrence in 6 of 71 (8.4%). Six of 49 (12.2%) patients treated with cyclosporine with or without mycophenolate mofetil and prednisolone experienced recurrence. Six of 36 (16.7%) patients treated with tacrolimus and prednisolone with or without mycophenolate mofetil experienced recurrence. Patients treated with cyclosporine had numerically fewer recurrences than those treated with tacrolimus (P=0.11). Conclusions. Patients with RPBC demonstrated prolonged survival. Clinical factors did not aid in predicting RPBC. The clinical course of RPBC appears to be different than in the earlier years of liver transplantation. Immunosuppression may play a role. The use and type of antimetabolite drugs had no affect on recurrence. RPBC demonstrated a different clinical course with tacrolimus treatment (shorter time to recurrence) and increased incidence when compared with cyclosporine treatment. Controlled randomized studies are necessary to determine differences between tacrolimus and cyclosporine treatment, if any.

Original languageEnglish (US)
Pages (from-to)1583-1588
Number of pages6
JournalTransplantation
Volume76
Issue number11
DOIs
StatePublished - Dec 15 2003
Externally publishedYes

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Biliary Liver Cirrhosis
Liver Transplantation
Recurrence
Cyclosporine
Tacrolimus
Prednisolone
Mycophenolic Acid
Transplants
Muromonab-CD3
Antimetabolites
Liver
Azathioprine
Immunosuppression
Liver Diseases
Therapeutics
Databases

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Sanchez, E. Q., Levy, M. F., Goldstein, R. M., Fasola, C. G., Tillery, G. W., Netto, G. J., ... Klintmalm, G. B. (2003). The changing clinical presentation of recurrent primary biliary cirrhosis after liver transplantation. Transplantation, 76(11), 1583-1588. https://doi.org/10.1097/01.TP.0000090867.83666.F7

The changing clinical presentation of recurrent primary biliary cirrhosis after liver transplantation. / Sanchez, Edmund Q.; Levy, Marlon F.; Goldstein, Robert M.; Fasola, Carlos G.; Tillery, Glenn W.; Netto, George J.; Watkins, David L.; Weinstein, Jeffrey S.; Murray, Natalie G.; Byers, Derek; Christensen, Laura L.; Klintmalm, Goran B.

In: Transplantation, Vol. 76, No. 11, 15.12.2003, p. 1583-1588.

Research output: Contribution to journalArticle

Sanchez, EQ, Levy, MF, Goldstein, RM, Fasola, CG, Tillery, GW, Netto, GJ, Watkins, DL, Weinstein, JS, Murray, NG, Byers, D, Christensen, LL & Klintmalm, GB 2003, 'The changing clinical presentation of recurrent primary biliary cirrhosis after liver transplantation', Transplantation, vol. 76, no. 11, pp. 1583-1588. https://doi.org/10.1097/01.TP.0000090867.83666.F7
Sanchez, Edmund Q. ; Levy, Marlon F. ; Goldstein, Robert M. ; Fasola, Carlos G. ; Tillery, Glenn W. ; Netto, George J. ; Watkins, David L. ; Weinstein, Jeffrey S. ; Murray, Natalie G. ; Byers, Derek ; Christensen, Laura L. ; Klintmalm, Goran B. / The changing clinical presentation of recurrent primary biliary cirrhosis after liver transplantation. In: Transplantation. 2003 ; Vol. 76, No. 11. pp. 1583-1588.
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title = "The changing clinical presentation of recurrent primary biliary cirrhosis after liver transplantation",
abstract = "Background. Recurrent Disease After Liver Trans-Plant Is a significant problem. Recurrent primary biliary cirrhosis (RPBC) is a histologic diagnosis. Clinical data is unreliable in predicting or diagnosing recurrence. RPBC appears to have a changing clinical presentation in recent years. Materials and Methods. The diagnosis of RPBC after liver transplantation was made histologically. Data were obtained from our prospectively maintained liver-transplant database and evaluated statistically. Results. Between 1985 and 1999, 1,835 liver transplants were performed, 169 for PBC. One hundred fifty-six patients were evaluated (one patient received retransplantation, and 13 were excluded). Seventeen (10.9{\%}) experienced recurrence. Median posttransplantation follow-up time was 72.1 months. Median time to recurrence was 49.6 months. Median follow-up time after recurrence was 11.5 months. Neither acute rejection episodes (P=0.34) nor OKT3 use (P=0.36) before diagnosis of recurrence was significant. The combination of cyclosporine, azathioprine, and prednisolone demonstrated recurrence in 6 of 71 (8.4{\%}). Six of 49 (12.2{\%}) patients treated with cyclosporine with or without mycophenolate mofetil and prednisolone experienced recurrence. Six of 36 (16.7{\%}) patients treated with tacrolimus and prednisolone with or without mycophenolate mofetil experienced recurrence. Patients treated with cyclosporine had numerically fewer recurrences than those treated with tacrolimus (P=0.11). Conclusions. Patients with RPBC demonstrated prolonged survival. Clinical factors did not aid in predicting RPBC. The clinical course of RPBC appears to be different than in the earlier years of liver transplantation. Immunosuppression may play a role. The use and type of antimetabolite drugs had no affect on recurrence. RPBC demonstrated a different clinical course with tacrolimus treatment (shorter time to recurrence) and increased incidence when compared with cyclosporine treatment. Controlled randomized studies are necessary to determine differences between tacrolimus and cyclosporine treatment, if any.",
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T1 - The changing clinical presentation of recurrent primary biliary cirrhosis after liver transplantation

AU - Sanchez, Edmund Q.

AU - Levy, Marlon F.

AU - Goldstein, Robert M.

AU - Fasola, Carlos G.

AU - Tillery, Glenn W.

AU - Netto, George J.

AU - Watkins, David L.

AU - Weinstein, Jeffrey S.

AU - Murray, Natalie G.

AU - Byers, Derek

AU - Christensen, Laura L.

AU - Klintmalm, Goran B.

PY - 2003/12/15

Y1 - 2003/12/15

N2 - Background. Recurrent Disease After Liver Trans-Plant Is a significant problem. Recurrent primary biliary cirrhosis (RPBC) is a histologic diagnosis. Clinical data is unreliable in predicting or diagnosing recurrence. RPBC appears to have a changing clinical presentation in recent years. Materials and Methods. The diagnosis of RPBC after liver transplantation was made histologically. Data were obtained from our prospectively maintained liver-transplant database and evaluated statistically. Results. Between 1985 and 1999, 1,835 liver transplants were performed, 169 for PBC. One hundred fifty-six patients were evaluated (one patient received retransplantation, and 13 were excluded). Seventeen (10.9%) experienced recurrence. Median posttransplantation follow-up time was 72.1 months. Median time to recurrence was 49.6 months. Median follow-up time after recurrence was 11.5 months. Neither acute rejection episodes (P=0.34) nor OKT3 use (P=0.36) before diagnosis of recurrence was significant. The combination of cyclosporine, azathioprine, and prednisolone demonstrated recurrence in 6 of 71 (8.4%). Six of 49 (12.2%) patients treated with cyclosporine with or without mycophenolate mofetil and prednisolone experienced recurrence. Six of 36 (16.7%) patients treated with tacrolimus and prednisolone with or without mycophenolate mofetil experienced recurrence. Patients treated with cyclosporine had numerically fewer recurrences than those treated with tacrolimus (P=0.11). Conclusions. Patients with RPBC demonstrated prolonged survival. Clinical factors did not aid in predicting RPBC. The clinical course of RPBC appears to be different than in the earlier years of liver transplantation. Immunosuppression may play a role. The use and type of antimetabolite drugs had no affect on recurrence. RPBC demonstrated a different clinical course with tacrolimus treatment (shorter time to recurrence) and increased incidence when compared with cyclosporine treatment. Controlled randomized studies are necessary to determine differences between tacrolimus and cyclosporine treatment, if any.

AB - Background. Recurrent Disease After Liver Trans-Plant Is a significant problem. Recurrent primary biliary cirrhosis (RPBC) is a histologic diagnosis. Clinical data is unreliable in predicting or diagnosing recurrence. RPBC appears to have a changing clinical presentation in recent years. Materials and Methods. The diagnosis of RPBC after liver transplantation was made histologically. Data were obtained from our prospectively maintained liver-transplant database and evaluated statistically. Results. Between 1985 and 1999, 1,835 liver transplants were performed, 169 for PBC. One hundred fifty-six patients were evaluated (one patient received retransplantation, and 13 were excluded). Seventeen (10.9%) experienced recurrence. Median posttransplantation follow-up time was 72.1 months. Median time to recurrence was 49.6 months. Median follow-up time after recurrence was 11.5 months. Neither acute rejection episodes (P=0.34) nor OKT3 use (P=0.36) before diagnosis of recurrence was significant. The combination of cyclosporine, azathioprine, and prednisolone demonstrated recurrence in 6 of 71 (8.4%). Six of 49 (12.2%) patients treated with cyclosporine with or without mycophenolate mofetil and prednisolone experienced recurrence. Six of 36 (16.7%) patients treated with tacrolimus and prednisolone with or without mycophenolate mofetil experienced recurrence. Patients treated with cyclosporine had numerically fewer recurrences than those treated with tacrolimus (P=0.11). Conclusions. Patients with RPBC demonstrated prolonged survival. Clinical factors did not aid in predicting RPBC. The clinical course of RPBC appears to be different than in the earlier years of liver transplantation. Immunosuppression may play a role. The use and type of antimetabolite drugs had no affect on recurrence. RPBC demonstrated a different clinical course with tacrolimus treatment (shorter time to recurrence) and increased incidence when compared with cyclosporine treatment. Controlled randomized studies are necessary to determine differences between tacrolimus and cyclosporine treatment, if any.

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