Bass, MD,PhD. answers questions re PBC.

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This is from the PBCers Digest. Joanne

The following questions were answered by:

M. Bass, MD, PhD

Professor of Medicine

Medical Director, UCSF Liver Transplantation Service

Division of Gastroenterology

University of California Medical Center and School of Medicine

San Francisco, CA

Question 1

Should a transplant recipient refer to PBC in the present or past tense (i.e.

'I have

PBC' or 'I had PBC')? Any statistics about reoccurence?

Answer 1

PBC clearly does not go away permanently following a liver transplant. The

AMA persists in almost all patients who had this before transplant, and subtle

changes on liver biopsy accompanied by asymptomatic liver enzyme changes during

long term follow-up are very common. To some extent or another, this can be

found in up to 50% of PBC patients followed for more than 5 years out from a

liver transplant. However - and this is key - although recurrence in this

technical sense appears common, actual clinical disease is very uncommon. Only

about 10% of all patients transplanted with PBC ever get disease recurrence that

is so severe as to require re-transplantation. How one refers to this

situation (i.e., past or present tense), really depends on how you feel, and how you

want to relate to your condition. If you feel great, then look at it as past

tense. I think the main challenge for most PBC patients after liver transplant

is to avoid worrying about clinically insignificant, and non-progressive PBC

recurrence.

Question 2

I have had uveitis for several months and the eye doctor is concerned that it

continues to "smolder" and not go away. While this is an autoimmune eye

disorder, I wonder if my PBC has anything to do with it? Would steroid

treatment

be detrimental for my liver?

Answer 2

There are quite a number of autoimmune disease associations with PBC. Uveitis

is certainly not a common one. Your uveitis may require treatment with

corticosteroids, and there is really no way to avoid this, although there are a

host of immunosuppressive treatments that are used. The best treatment will be

decided by your eye specialist. Actually, the steroids will not harm your

liver, and there is even some evidence that steroids may be beneficial to the liver

in early stage PBC. If you remain on steroids for a long time - more than 3

months, the main concern will be for bone thinning, so you should have

monitoring on your bone density.

Question 3

Is a virtual colonoscopy as effective as a traditional colonoscopy? Are

there any risks involved?

Answer 3

Virtual colonoscopy has been reported to be as good as actual colonoscopy for

polyp and cancer screening by groups who have specialized in the development

of this technique. But it is not consistently as reliable in everyone's hands.

Also, you cannot have a biopsy of a suspicious lesion or removal of a polyp

at the time of a virtual colonoscopy. Actual colonoscopy is very safe and

effective. I believe the consensus on virtual colonoscopy is that it is still

seen as promising, but not ready to replace actual colonoscopy for screening and

diagnostic purposes.

Question 4

If one is allergic to the penicillin drugs, what family of antibiotics would

you

suggest that would be less hepatotoxic to the liver? Would the Quinolones be

less

toxic?

Answer 4

The choice of antibiotics would depend to a large degree on what is being

treated. Quinolones are used extensively in patients who are allergic to

penicillins, and are usually very safe for the liver.

Question 5

I have AIH/PBC overlap and diagnosed with idiopathic avascular osteonecrosis

of

the right knee. From what I've read, this can be caused by long-term, high

dose

corticosteroid use, as well as liver disease. However, I've not been able to

find

out exactly what liver disease(s) can cause this. Can PBC cause this

disease?

Answer 5

I have personally never seen avascular osteonecrosis as a result of PBC nor

have I found this described in the recent literature. There is a report from

the 1970's describing a form of arthritis in patients with PBC that looked like

avascular osteonecrosis. This appeared to be strongly associated with

scleroderma. The commonest cause of this problem is treatment with corticosteroids,

and in PBC patients, the problem is seen for the most part, after liver

transplantation in patients whose immunosuppression includes prednisone. Patients

with AIH can certainly get this problem, but it is always attributed to the use

of usually relatively high dose corticosteroids.

Question 6

Many hepatologists say that if PBC is diagnosed early and the patient starts

taking Urso, that a transplant will most likely never be needed.

What is considered "early?" Is it within the first ten years? Within the

first year,

first five years? Without symptoms? Please explain.

Answer 6

Early in this context usually means early stage of disease, i.e., stage I or

II disease on the basis of liver biopsy. Time has some bearing on this

process, but some patients will remain stable at an early stage for many years; some

hardly seem to progress. Others progress through the stages more rapidly and

are destined for liver transplant. The more advanced the disease on liver

biopsy, the more likely the patient will have symptoms, although this is certainly

not an absolute.

END

Jj Cathcart

jjcathcart@...

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