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Efficacy of Liver Transplantation in Patients with Primary Biliary Cirrhosis

Markus, BH and Dickson, ER and Grambsch, PM and Fleming, TR and Mazzaferro, V and Klintmalm, GBG and Wiesner, RH and Van Thiel, DH and Starzl, TE (1989) Efficacy of Liver Transplantation in Patients with Primary Biliary Cirrhosis. New England Journal of Medicine, 320 (26). 1709 - 1713. ISSN 0028-4793

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Abstract

No controlled trials have been performed to assess the efficacy of liver transplantation. Because of the marked improvement in survival after liver transplantation since 1981, random assignment of patients to a control group not undergoing transplantation is considered clinically inappropriate. To assess the efficacy of liver transplantation in patients with primary biliary cirrhosis, we compared survival in 161 patients with this diagnosis who had undergone a liver transplantation with survival in patients with the same diagnosis who had been treated conservatively. The comparison was performed with use of a recently developed statistical technique, the Mayo model. All patients had undergone liver transplantation between March 1980 and June 1987 and were followed for a median of 25 months. Three months after liver transplantation, the Kaplan–Meier survival probabilities in the recipients were substantially higher than the Mayo-model “simulated-control” survival probabilities (P<0.001). At two years, the Kaplan–Meier survival probability was 0.74, whereas the mean Mayo-model survival probability was 0.31. The patients who were at low risk according to the Mayo model had the best probability of survival after liver transplantation; however, patients at all risk levels who had undergone liver transplantation had higher probabilities of survival than those who had not. We conclude that liver transplantation is an efficacious treatment in patients with advanced primary biliary cirrhosis. (N Engl J Med 1989; 320:1709–13.), LIVER transplantation has been accepted clinically as a lifesaving treatment in various end-stage liver diseases, including primary biliary cirrhosis.1,2 However, no controlled trials have been performed to evaluate the efficacy of this procedure. Indeed, because there has been a marked improvement since 1981 in survival after transplantation, random assignment of patients with advanced liver disease to a nontransplantation control group is considered to be clinically inappropriate. At the Mayo Clinic, a Cox regression model for predicting the probability of survival in patients with conservatively treated primary biliary cirrhosis has been developed.3 To provide control data for assessing the efficacy of…. © 1989, Massachusetts Medical Society. All rights reserved.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Markus, BH
Dickson, ER
Grambsch, PM
Fleming, TR
Mazzaferro, V
Klintmalm, GBG
Wiesner, RH
Van Thiel, DH
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute
Date: 29 June 1989
Date Type: Publication
Journal or Publication Title: New England Journal of Medicine
Volume: 320
Number: 26
Page Range: 1709 - 1713
DOI or Unique Handle: 10.1056/nejm198906293202602
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0028-4793
Other ID: uls-drl:31735062121979, Starzl CV No. 969
Date Deposited: 08 Apr 2010 17:16
Last Modified: 02 Feb 2019 13:57
URI: http://d-scholarship.pitt.edu/id/eprint/4355

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