Factors influencing post-transplant mortality in primary biliary cholangitis.

Introduction: Primary Biliary Cholangitis (PBC) is a significant cause of end stage liver disease and hepatocellular carcinoma necessitating liver transplant. Little data exists on the natural history of PBC post liver transplant. Our goal was to identify factors which predispose an individual to either recurrent PBC or death after liver transplantation. Methods: All patients with PBC who received a transplant from 1/2001-3/2016 were included, yielding 51 patients. Relevant data collected include: patient demographics, transplant type (deceased vs. living related vs. living unrelated), cold ischemia time, warm ischemia time, immunosuppressive regimen, pre-transplant MELD, AMA titer, ursodiol prophylaxis, 1, 3 and 5yr mortality, presence of disease recurrence, acute or chronic rejection, and cause of death. Fisher\u27s exact tests and two sample T-tests were used to assess association of these variables with disease recurrence and mortality. Results: 51 patients (49 female) with a mean age of 64.6 years received liver transplant for PBC. 75% (n=38) were on tacrolimus, 69% (n=35) on cellcept, and 18% (n=9) on cyclosporine. 86% (n=42) had ursodiol prophylaxis. 6 patients (12%) died within 1 year post-transplant. Patients on tacrolimus had statistically significant lower rates of 1 year mortality (5% vs. 31%, p=.041). In addition, patients on ursodiol prophylaxis had a statistically significant lower rate of 1 year (5% vs. 43%, p=.016) and 5 year mortality (16% vs. 57%, p=.033) compared to those without ursodiol prophylaxis. 6/43 (14%) had disease recurrence, in which the only statistically significant variable was younger age (57.3 vs. 67 years, p=0.039). Conclusion: Improved knowledge on factors which predispose a patient to PBC reoccurrence and mortality will allow for improved disease monitoring post liver transplant. Our results suggest that patients with PBC who receive a liver transplant have statistically significant lower 1- and 5-year mortality rates when managed with ursodiol prophylaxis and statistically significant lower 1-year mortality rate when using tacrolimus for immunosuppression