Baseline ductopenia and treatment response predict long-term histological progression in primary biliary cirrhosis.
OBJECTIVE
Laboratory and pathological predictors of future histological progression in primary biliary cirrhosis (PBC) are needed for routine practice and clinical trials. We sought to develop clinically meaningful markers for those with predominantly early disease at risk of progressive liver damage.


METHODS
Patients with PBC (n=69) with a follow-up liver biopsy performed approximately 10 years after initial histological diagnosis were identified and reviewed.


RESULTS
Histological progression in the stage of fibrosis observed in paired liver biopsies from the same patient was associated with the absence of biochemical response to ursodeoxycholic acid (UDCA) at 2 years: alkaline phosphatase (ALP) >1.67 × ULN (upper limit of normal) (P=0.001, odds ratio (OR) 12.14, 95% confidence interval (CI) 2.69-54.74) when defined as an increase in one stage and ALP > 1.76 × ULN (P=0.03, OR 5.07, 95% CI 1.17-21.95) when defined as an increase in two stages. Ductopenia (>50% loss), as formally evaluated through blinded biopsy review of liver tissue obtained at initial diagnosis in a subset of 34 patients, predicted histological progression (P=0.012), along with biochemical response to UDCA (P=0.002). The presence of interface hepatitis in the same biopsies did not.


CONCLUSIONS
Patients with PBC who fail to show a biochemical response to UDCA or who have ductopenia on baseline biopsy progress histologically during extended follow-up. Such patients may benefit from novel treatments, with our exploratory data providing a means of identifying these individuals early in their disease.
Kumagi
Teru
T
Liver Centre, Toronto Western Hospital, University Health Network, Ontario, Canada.
Guindi
Maha
M
Fischer
Sandra E
SE
Arenovich
Tamara
T
Abdalian
Rupert
R
Coltescu
Catalina
C
Heathcote
E Jenny
EJ
Hirschfield
Gideon M
GM
D000328:Adult; D000469:Alkaline Phosphatase / Q000097:blood; D018450:Disease Progression; D005260:Female; D006801:Humans; D007136:Immunoglobulins / Q000097:blood; D008099:Liver / Q000187:drug effects / Q000473:pathology*; D008105:Liver Cirrhosis, Biliary / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*
D007136:Immunoglobulins; D014580:Ursodeoxycholic Acid; D000469:Alkaline Phosphatase