LONG TERM USE OF URSODIOL IN POST-LIVER TRANSPLANT PATIENTS INCREASES BILIARY COMPLICATIONS
Ashraf T, Mendiratta V, Gill S, Ahmed A, and Jafri SM. LONG TERM USE OF URSODIOL IN POST-LIVER TRANSPLANT PATIENTS INCREASES BILIARY COMPLICATIONS. Hepatology 2020; 72:821A-822A.
Background: Studies suggest ursodiol has beneficial effects in reducing liver enzymes during the first 4 weeks after liver transplantation (LT) as well as incidence of biliary casts and sludge in the first year. Hepatologists often continue ursodiol indefinitely despite evidence of improvement in long-term outcomes. This retrospective study evaluates ursodiol and its effect on LT outcomes over a 3-year period. Methods: A retrospective study of LT candidates transplanted between 5/2014- 10/2016 at our institution was performed. Patients with primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis were excluded and a total of 284 patients were recorded. Relevant data collected included: patient demographics, reason for transplantation, cold ischemic time, ursodiol use and dosage, presence and severity of rejection, number of hospitalizations, occurrences of biliary complications and mortality. Biliary complications were defined as strictures or leaks. Statistics were calculated using analysis of variance (ANOVA), chi-square, Fisher’s exact test and Wilcoxon Rank Sum Test. Results: 284 liver transplants were performed in 180 males and 104 females with a mean age of 57.5. Ursodiol use was 62% at 6 months, 55% at 12 months, 45.4% at 2 years and 26.8% at 3 years. Univariate analysis showed that in spite of ursodiol use there remained a significant increase in biliary complications when compared to no use at 6 months (28.4% vs 10.3% p = <0.001) and between 6-12 months (10.3% vs 1.9% p= 0.010). This was again seen at 1-2 years (9.2% vs 3.3% p=0.053) and at 2-3 years (10.4% vs 2.8% p=0.055). There was no significant difference in mortality associated with use at 6 months (10.2% vs 8.3% p = 0.597) or 12 months (8.4% vs 8.3% p=0.982). There was consistently no significant difference in the number of hospitalizations, moderate or severe rejections at any time point (Table 1). This was true when analyzing all rejections at 6 months, 12 months, 2 years and 3 years as well (p=0.248, p=0.333, p=0.275 and p=0.100). Conclusion: Our data shows no long-term benefit of ursodiol use on mortality, re-admission rate, or number of rejections at 3 years post-transplant. Ursodiol does not reduce incidence of biliary complications in patients where medication was used for this purpose and instead increases number of biliary complications at 6 and 12 months. This suggests that ursodiol does not have long term protective effects and should be weaned off in the vast majority of patients.