Abstract:

Objective To observe the effect of liver transplantation in the treatment of primary biliary cholangitis (PBC) and prognosis. Methods The clinical data of PBC patients treated with liver transplantation from January 2001 to December 2020 in Ruijin Hospital, Shanghai Jiao Tong University School of Medicine and Shanghai Changzheng Hospital were analyzed retrospectively. A total of 10 preoperative parameters for immunoinflammatory response including systematic immunoinflammatory index, fibrinogen, the ratio among neutrophil, lymphocyte, monocyte, platelet, aspartic aminotransferase, CD4 and CD8 were used to reflect immunoinflammatory response. Score was calculated with monocyte-lymphocyte ratio and fibrinogen. There were higher risk group according to the score ≥-0.12 and lower risk group according to the score <-0.12. Survival rate was analyzed using life table method, and multivariate analysis was done with Logistic regression model and COX regression. Results Totally, 82 patients were enrolled. Postoperative follow-up was performed until to December 31, 2021 with a median 4.54 years follow-up from 2 day to 17.06 year. Survival rate of 1-, 3-, 5-, 10-, and 15-year of 82 patients with PBC after liver transplantation were 85%, 79%, 79%, 79%, 47%, respectively, with survival time of 12.92 years. Multivariate analysis of PBC patients after liver transplantation using preoperative index showed that aspartate aminotransferase-to-platelet ratio was an independent risk factor for 90-day survival(P=0.013), and monocyte-to-lymphocyte ratio with fibrinogen were independent risk factors for postoperative length of stay(P=0.002; P=0.007). Both hospitalization cost and length of stay in higher risk group was significant more than those in lower risk group. Conclusions Pre-operative immunoinflammatory response may affect the short-term prognosis of patients with PBC after liver transplantation.

Key words: Primary biliary cholangitis, Liver transplantation, Preoperative immunoinflammatory index