A new systematic review and meta-analysis published in the American Journal of Transplantation explores how often primary biliary cholangitis (PBC) recurs after liver transplantation and what factors influence this risk.
The study, which included 54 cohort and cross-sectional studies covering 5,710 patients worldwide, found that recurrent PBC affects about 15% of transplant recipients, occurring at a rate of 28.5 cases per 1,000 person-years.
While recurrence has long been recognized as a potential threat following transplantation, previous estimates varied widely because of inconsistent diagnostic criteria and small study sizes. By focusing only on cases confirmed through liver biopsy (the diagnostic gold standard), the researchers provided a more reliable estimate of recurrent PBC’s global burden.
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The researchers also found that recurrence rates differed from country to country. This suggests that local factors, such as environment, genetics or transplant practices, might play a role in PBC recurrence.
Additionally, the study identified key factors that influence risk. Use of cyclosporine as a maintenance immunosuppressant was associated with a 47% lower risk of PBC recurrence, while corticosteroids reduced risk by about 35%. In contrast, tacrolimus, a more commonly used agent in modern transplant medicine, was linked to an 80% higher recurrence risk during long-term maintenance. Each extra year of age at the time of transplant slightly lowered the chance of recurrence, suggesting that younger patients are more at risk.
A subanalysis that accounted for changes in immunosuppression practices since the 1990s found that cyclosporine remained protective during maintenance therapy, but tacrolimus appeared beneficial when used early after transplantation. This distinction likely reflects shifts in posttransplant care and monitoring over time.
Recurrent PBC did not appear to significantly affect overall patient survival, though data was limited. Still, recurrence can affect the liver over time, so finding the right combination of posttransplant medications remains important.
The researchers suggest that future studies should explore how best to tailor immunosuppression and whether adding treatments like ursodeoxycholic acid might further reduce recurrence risk.
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