Background: A decrease in the need for liver transplantations (LTX) in Primary Biliary Cirrhosis (PBC), possibly related to treatment with ursodeoxycholic acid (UDCA), has been reported in the USA and UK. The aim of this study was to assess LTX requirements in PBC over the past 20 years in the Netherlands.Methods: Analysis of PBC transplant data of the Dutch Organ Transplant Registry during the period 1988-2008, including both absolute and proportional numbers. The indication for LTX was categorized as liver failure, hepatocellular carcinoma or poor quality of life (severe fatigue or pruritus). Data were analysed for two decades: 1.1.1988-31.12.1997 (1st) and 1.1.1998-31.12.2007 (2nd). The severity of disease was quantified using MELD scores. To fit lines which show trends over time we applied a linear regression model.Results: A total of 110 patients (87% women) was placed on the waiting list. 105 patients were transplanted (1st: 61, 2nd: 44), 5 (5%) died while listed. The absolute annual number of LTX for PBC slightly decreased during the 20 year period, the proportional number decreased significantly. At the time of LTX the mean age was 53.6 yrs. (1st: 53.4, 2nd: 53.8), the mean MELD score 13.9 (1st:14.5, 2nd:13.0). The median interval from diagnosis to LTX was 90.5 months (1st:86.5, 2nd: 93.5). 69% of patients was treated with UDCA (1st38%, 2nd82%).Conclusions: Over the past 20 years the absolute number of LTX for PBC in the Netherlands showed a tendency to decrease whereas the proportional decrease was significant. There was a trend over time toward earlier transplantation.

MELD score, Netherlands, adult, age, alanine aminotransferase, alanine aminotransferase blood level, albumin, albumin blood level, alkaline phosphatase, alkaline phosphatase blood level, article, aspartate aminotransferase, aspartate aminotransferase blood level, bilirubin, bilirubin blood level, creatinine, creatinine blood level, disease severity, drug use, fatigue, female, hospital admission, human, international normalized ratio, liver cell carcinoma, liver failure, liver transplantation, major clinical study, male, mortality, primary biliary cirrhosis, prognosis, pruritus, quality of life, scoring system, sex difference, treatment indication, trend study, ursodeoxycholic acid
dx.doi.org/10.1186/1471-230X-10-144, hdl.handle.net/1765/22960
B M C Gastroenterology
Erasmus MC: University Medical Center Rotterdam

Kuiper, E.M.M, Hansen, B.E, Metselaar, H.J, de Man, R.A, Haagsma, E.B, van Hoek, B, & van Buuren, H.R. (2010). Trends in liver transplantation for primary biliary cirrhosis in the Netherlands 1988-2008. B M C Gastroenterology, 10. doi:10.1186/1471-230X-10-144