Transplantation Trends in Primary Biliary Cirrhosis

Background & Aims: Ursodeoxycholic acid (UDCA) has shown efficacy in primary biliary cirrhosis (PBC), a chronic, slowly progressive disease. We hypothesized that UDCA use would reduce the need for liver transplantation in PBC. Our study's aim was to assess liver transplantation requirements in PBC over a 12-year period. For comparison, we studied patients with primary sclerosing cholangitis (PSC) because it shares similar characteristics to PBC, but with a decreased response to UDCA. Methods: PBC and PSC transplant data of first-time liver recipients from the United Network for Organ Sharing database were collected from 1995 to 2006. Results: The absolute number of liver transplantations in the United States increased an average of 249 transplants per year (P < .001). The absolute number of transplants performed for PBC decreased an average of 5.4 cases per year (P = .004). The absolute number of transplantations for PSC showed no statistical change (P = .621). The trends for the absolute number of individuals added to the transplant waitlist showed a similar pattern: (1) an increase in total listings for transplants of all diagnoses (β = 265; P = .001); (2) a decrease in PBC (β = -12.1; P < .001); (3) and no change for PSC (β = -5.434; P = .083). Conclusions: The liver transplantation burden of PBC in the United States decreased between 1995 and 2006. This is despite an increase in total liver transplants and no change in transplant rates for PSC.