UDCA Decreases Incidence of Primary Biliary Cholangitis and Biliary Complications after Liver Transplant: A Meta-Analysis.

INTRODUCTION After liver transplantation (LT), the role of ursodeoxycholic acid (UDCA) is not well characterized. We examine the effect of UDCA after LT in the prophylaxis of biliary complications (BC) in all-comers for LT and the prevention of recurrent primary biliary cholangitis (rPBC) in patients transplanted for PBC. METHODS Two authors searched PubMED/MEDLINE and Embase from January 1990 through December 2018 to identify all studies that evaluate the effectiveness of UDCA prophylaxis after LT for BC in all-comers recipients and rPBC after LT in patients transplanted for PBC. Odds ratios (ORs) were calculated for endpoints of the BC study. Pooled recurrence rates were calculated for rPBC. The study was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-analysis guideline. RESULTS Fifteen studies were included, comprising 530 patients in the analysis for biliary complications and 1,727 patients in the analysis for rPBC. UDCA was associated with decreased odds of biliary complications (OR 0.70, CI 0.52-0.93, p = 0.01) and biliary stones and sludge (OR 0.49, CI 0.24-0.77, p = 0.004). Prophylactic use of UDCA did not affect the odds of biliary stricture. For patients transplanted for PBC, prophylactic use of UDCA decreased the rate of rPBC (13.3%, CI 7.2-19.4%) compared to not using prophylactic UDCA (33.8%, CI 28.7-38.9%). CONCLUSION UDCA after LT reduces the odds of BC and bile stones and sludge in all-comer LT recipients and reduces or delays the incidence of rPBC in patients transplanted for PBC. UDCA use after LT could be considered in all LT recipients to reduce the odds of BC and may be particularly beneficial for patients transplanted for PBC by reducing the incidence of rPBC.