Time trends in liver transplantation for primary biliary cholangitis in Europe over the past three decades

Q.P. Janssen, M.H. Harms, R. Adam, C. Duvoux, H.R. van Buuren, B.E. Hansen, H.J. Metselaar

Friday 16 march 2018

11:50 - 12:00h at Van Rijck/Ruys Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 15: Clinical

Introduction

Primary biliary cholangitis (PBC) has long been a leading indication for liver transplantation (LT). Changes in selection criteria for LT and in the epidemiology of PBC, as well as the introduction of ursodeoxycholic acid as an effective treatment may be important factors that have changed the relative importance and actual performance of LT for PBC over time. The aims of this study were to assess trends in LT for PBC over the past 30 years in Europe, including potential changes in the relevant patient population.

Methods

Patients receiving LT between 1986-2015 in centres reporting to the European Liver Transplantation Registry (ELTR) were included. We excluded patients in case of combined organ transplantation or when aged

Results

During our 30-year study period, 112,874 patients underwent LT. In 6029 patients (5.3%) PBC was the primary indication. After an initial annual increase of 21.5 patients from 1986-1995, the absolute number of LTs for PBC reached a relatively steady state from 2006 onwards at approximately 200 LTs annually. The percentage of LT for PBC as compared to other aetiologies fell gradually from 20.3% in 1986 to 3.6% in 2015. PBC was the only indication showing a constant proportional decrease over three decades. In patients with PBC, median age at LT increased from 53.9 years (IQR47.3-59.4) in the first decade to 56.1 (IQR48.4-62.4) after 2006 (p<0.001). The proportion of males increased from 11.0% in the first to 15.1% in the third decade (p<0.001). Median MELD scores increased from 15.3 (IQR12.2-19.2) in 1996-2005 to 16.8 (IQR12.8-21.6) in 2006-2015 (p<0.001). In the Netherlands, 88.8% (71/80 evaluable patients) listed for LT could be classified as incomplete responders after one year of UDCA treatment according to the Paris-I criteria.

Conclusion

In our European-wide study on patterns in LT for PBC over 30 years, we show that despite a relative decrease, the absolute number of LTs for PBC patients has now reached a steady state. Still, more than 200 European patients with PBC undergo LT annually. Today, these patients are significantly older, have higher MELD scores, and are more likely to be males than 30 years ago.