From the Guidelines
Ursodeoxycholic acid (UDCA) is the medication that reduces the risk of recurrent primary biliary cholangitis (PBC) in patients undergoing liver transplantation, as it has been shown to prevent recurrence and improve long-term outcomes 1. The recommended dose of UDCA is 10-15 mg/kg/day, divided into two daily doses, and it should be continued indefinitely after transplantation. This medication works by reducing bile acid toxicity, protecting cholangiocytes from cytotoxic effects of hydrophobic bile acids, and having immunomodulatory and anti-inflammatory properties. Some key points to consider when using UDCA in patients with PBC undergoing liver transplantation include:
- Early initiation of UDCA therapy post-transplant is crucial for preventing recurrence 1
- UDCA has been shown to improve liver biochemistry, delay histological progression, and improve transplant-free survival in PBC patients 1
- Neither azathioprine, obeticholic acid, prednisone, nor versaprofen have demonstrated efficacy specifically for preventing PBC recurrence after liver transplantation
- The use of UDCA is recommended by the European Association for the Study of the Liver (EASL) as a lifelong treatment for patients with PBC after liver transplantation 1
From the Research
Medication Options for Reducing Recurrent PBC Risk
- Azothioprine: There is no evidence to suggest that azothioprine reduces the risk of recurrent PBC in patients undergoing liver transplantation 2, 3, 4, 5, 6.
- Abetocolic Acid (also known as Ursodeoxycholic Acid or UDCA): UDCA has been shown to reduce the risk of PBC recurrence after liver transplantation 2, 3, 4, 5.
- Prednisone: There is no evidence to suggest that prednisone reduces the risk of recurrent PBC in patients undergoing liver transplantation 2, 3, 4, 5, 6.
- Versaprofen (not mentioned in the provided studies) and Urso (another name for Ursodeoxycholic Acid): As mentioned earlier, UDCA (Urso) has been shown to reduce the risk of PBC recurrence after liver transplantation 2, 3, 4, 5.