Application value of liver transplantation for primary biliary cirrhosis

Abstract

Objective To investigate the application value of liver transplantation (LT) in the treatment of primary biliary cirrhosis (PBC). Methods Clinical data of 16 patients with PBC who underwent LT in the First Affiliated Hospital of Xi'an Jiaotong University Medical College between July 2006 and November 2016 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 4 cases were males and 12 females, aged (54±6) years old on average. Allogeneic modified piggyback orthotopic LT was performed in all patients. The general data, clinical symptoms, physical signs, laboratory test, intraoperative and postoperative conditions were observed. All patients received postoperative follow-up on a regular basis. Results Varying degrees of liver dysfunction and jaundice were observed in the patients before LT. Intraoperatively, 1 patient died from hemorrhagic shock and the remaining 15 cases successfully completed the surgery. The operation time was (378±67) min, the anhepatic phase time was (37±7) min, and the intraoperative blood loss was (2 389±1 319) ml. No postoperative surgical complications were observed. The median postoperative length of hospital stay was 21(9-56) d. Moderate degree of acute rejection was respectively observed at postoperative 40 and 60 d in 2 patients, and the liver function was gradually restored to normal after the immunosuppressive therapy was strengthened. Among the 2 patients, 1 case suffered from stress ulcer and was cured after administration of antiacid and decreasing the dosage of hormone, the other case suffered from acute cholangitis after the restoration of acute rejection, and underwent secondary LT at postoperative 2 years. During the follow-up, 2 cases lost to follow-up and 3 died. Among the 3 patients, 2 died from multiple organ failure induced by septicopyemia at postoperative 32 and 97 d, and 1 died from respiratory system-related complications at postoperative 2 years. Conclusions LT is the most effective treatment for PBC at present. Active preoperative evaluation and processing, and strict surgical procedures are the keys to the success of surgery. Rational postoperative administration of immunosuppressive agents and other adjuvant drugs can effectively prevent the recurrence of PBC. Key words: Liver cirrhosis, biliary; Liver transplantation; Ursodeoxycholic acidscopic