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Outcomes of Liver Transplant Candidates with Primary Biliary Cholangitis: The Data from the Scientific Registry of Transplant Recipients

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Abstract

Background

Primary biliary cholangitis (PBC) is progressive and can cause end-stage liver disease necessitating a liver transplant (LT). PBC patients may be disadvantaged on LT waitlist due to MELD-based priority listing or other factors.

Aim

The aim was to assess waitlist duration, waitlist mortality, and post-LT outcomes of PBC patients.

Methods

The Scientific Registry of Transplant Recipients data for 1994–2016 was utilized. Adult patients with PBC without hepatocellular carcinoma (HCC) were selected. Their clinico-demographic parameters and waitlist and post-transplant outcomes were compared to those of patients with hepatitis C (HCV) without HCC.

Results

Out of 223,391 listings for LT in 1994–2016, 8133 (3.6%) was for PBC without HCC. Mean age was 55.5 years, 76.9% white, 86.2% female, mean MELD score 21, 6.6% retransplants. There were 52,017 patients with hepatitis C included for comparison. The mean waitlist mortality was 17.9% for PBC and 17.6% for HCV (p > 0.05). The average transplantation rate was 57.7% for PBC and 53.3% for HCV (p < 0.0001), while waitlist dropout (death or removal due to deterioration) rate was 25.0% for PBC and 25.4% for HCV (p > 0.05). There was no significant difference in median waiting duration till transplantation between PBC patients and HCV after 2002 (103 vs. 95 days, p > 0.05). Post-LT mortality and graft loss rates were significantly lower in PBC than in HCV patients (all p < 0.02).

Conclusions

Despite no evidence of impaired waitlist outcomes and favorable post-transplant survival in patients with PBC, there is still a high waitlist dropout rate suggesting the presence of an unmet need for effective treatment.

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Abbreviations

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

HRSA:

The Health Resources and Services Administration

LT:

Liver transplantation

MELD:

The model for end-stage liver disease

OCA:

Obeticholic acid

OPTN:

Organ procurement and transplantation network

PBC:

Primary biliary cholangitis

SRTR:

Scientific registry of transplant recipients

UDCA:

Ursodeoxycholic acid

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Acknowledgments

The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government.

Funding

The study was funded by Intercept Pharmaceutical and the Center for Outcomes Research in Liver Diseases.

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Authors and Affiliations

  1. Department of Medicine, Center for Liver Disease, Inova Fairfax Hospital, Falls Church, VA, USA

    Mehmet Sayiner & Zobair M. Younossi

  2. Betty and Guy Beatty Center for Integrated Research, Claude Moore Health Education and Research Building, Inova Health System, 3300 Gallows Road, Falls Church, VA, 22042, USA

    Mehmet Sayiner, Leyla De Avila, Pegah Golabi, Andrei Racila & Zobair M. Younossi

  3. Center for Outcomes Research in Liver Diseases, Washington, DC, USA

    Maria Stepanova & Andrei Racila

Authors
  1. Mehmet Sayiner
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  2. Maria Stepanova
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  3. Leyla De Avila
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  4. Pegah Golabi
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  6. Zobair M. Younossi
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Correspondence to Zobair M. Younossi.

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Conflict of interest

ZMY is a consultant to BMS, Gilead, AbbVie, Intercept, and GSK. All other authors of this manuscript have no conflicts of interest to disclose.

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Sayiner, M., Stepanova, M., De Avila, L. et al. Outcomes of Liver Transplant Candidates with Primary Biliary Cholangitis: The Data from the Scientific Registry of Transplant Recipients. Dig Dis Sci 65, 416–422 (2020). https://doi.org/10.1007/s10620-019-05786-1

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  • DOI: https://doi.org/10.1007/s10620-019-05786-1

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