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Characteristics and Outcomes of Liver Transplantation for Primary Biliary Cholangitis in Young Patients

Analysis of the United Network for Organ Sharing Database

Singh, Amandeep, MD1; Fritze, Danielle, MD2; Mansouri, Mahsa, MD3; Lopez, Rocio4; Poordad, Fred, MD2,3; Lawitz, Eric, MD2,3; Cigarroa, Francisco, MD2; Halff, Glen, MD2; Alkhouri, Naim, MD3

doi: 10.1097/TP.0000000000002501
Original Clinical Science—Liver
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Background. Primary biliary cholangitis (PBC) in younger patients has been suggested to require liver transplantation (LT) in early adulthood, but data is limited on its outcomes. We aimed to evaluate the characteristics and outcome of LT in young patients with PBC in comparison with older adults.

Methods. The United Network for Organ Sharing database was analyzed for all patients with PBC who underwent LT between 2000 and 2012. Based on age at the time of LT, subjects were divided into 2 groups: young patients (≤40 y) and older adults (≥41 y). Baseline demographics, clinical parameters, and outcomes of LT were then compared between the 2 groups. Univariable and multivariable analyses were performed to assess the factors associated with outcomes of LT.

Results. A total of 2084 patients with PBC were included in the analysis with 158 young patients. Compared with older adults, younger patients were more likely to be male (27.2% versus 15.4%) and nonwhite (43.7% versus 21.5%), but they were less likely to have obesity, diabetes, or hypertension (P < 0.05) and had a lower mortality (8.2% versus 15.1%) but higher retransplantation rate (14.6% versus 4.7%) (P < 0.001). On multivariable analysis, older age, dialysis or ventilator use, and lower albumin were associated with high post-LT mortality.

Conclusions. Compared with older adults, early-onset PBC in younger patients requiring LT had higher percentage of males and nonwhites and had a lower prevalence of metabolic comorbidities but higher retransplantation rates. Further studies are warranted to confirm these findings.

1 Department of Gastroenterology & Hepatology, Center for Human Nutrition, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH.

2 Transplant Center, University of Texas Health at San Antonio, San Antonio, TX.

3 Texas Liver Institute, San Antonio, TX.

4 Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH.

Received 11 June 2018. Revision received 10 October 2018.

Accepted 17 October 2018.

A.S. and D.F. are the first authors.

The authors declare no funding or conflicts of interest.

N.A., A.S., and D.F. participated in the study concept and design. N.A., D.F., M.M., and A.S. participated in the acquisition of data. A.S., D.F., R.L., and N.A. participated in the analysis and interpretation of data. All authors participated in the drafting of the manuscript and critical revision of the manuscript for important intellectual content. R.L., A.S., D.F., and N.A. participated in the statistical analysis. F.P., E.L., F.C., and G.H. participated in the administrative, technical, or material support. N.A. participated in the study supervision.

Correspondence: Amandeep Singh, MD, Department of Gastroenterology and Hepatology, A-5, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. (singha4@ccf.org).

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