A controlled trial of cyclosporine in the treatment of primary biliary cirrhosis

Article Abstract:

Primary biliary cirrhosis is a chronic liver disease in which the flow of bile is disrupted. The actual cause of the disease is not known, but an autoimmune reaction (the body mounts an immune response to normal body components) causes destruction of the bile ducts, and leads to the blockage of the flow of bile, cirrhosis of the liver, and eventually, liver failure. There is no treatment available for primary biliary cirrhosis. The safety and effectiveness of a low-dose of the drug cyclosporine was studied in patients with this disease who did not yet have severe damage to the bile ducts (as exhibited by an absence of degeneration of the liver and portal hypertension). Cyclosporine suppresses immune reactions and is used in the treatment of many autoimmune diseases. Nineteen patients received cyclosporine and 10 patients received a placebo or inactive substance. Complete remission was not achieved in any of the patients, but after one year of treatment, patients treated with cyclosporine improved, with 17 of 19 patients having less or the same degree of tiredness and 18 of 19 having less itching, compared with the control group, in which 4 of 10 patients were more tired and 6 had increased itching. Patients treated with cyclosporine had significantly improved liver function and demonstrated a suppressed autoimmune response. After two years of therapy, liver biopsies were taken and only 1 of 13 patients treated with cyclosporine showed progression of primary biliary cirrhosis, compared with 5 of 7 in the control group. Side effects of the cyclosporine treatment included toxicity in the kidneys and increased blood pressure. Because of the side effects, treatment was temporarily discontinued in some of the patients, but the side effects were not so severe that treatment had to be discontinued permanently. Although cyclosporine therapy appears to be safe and effective for patients with primary biliary cirrhosis, further studies are necessary. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drug therapy, Autoimmune diseases, Cyclosporine, Cyclosporins, Biliary tract diseases, Biliary cirrhosis

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Efficacy of liver transplantation in patients with primary biliary cirrhosis

Article Abstract:

There has been a marked increase since 1981 in the survival rate for liver transplantation patients; therefore patients who had undergone liver transplantation between March 1980 and June 1987 were compared with patients with the same diseases who had not undergone transplantation. Three months after transplantation, the transplant patients had a higher chance of surviving than non-transplant patients would have had, as estimated by a statistical technique. Two years after transplantation, the transplant patients had a 75 percent chance of surviving, while non-transplant patients would have had only a 30 percent chance. The transplant patients with the lowest risk of death according to the Mayo model of death risk were most likely to survive. However, at all risk levels, transplant patients had a better chance of survival than did non-transplant patients. Thus liver transplantation is useful to patients with advanced primary biliary cirrhosis, a rare disease in which some of the bile ducts in the liver are destroyed.

Surgery

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Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis

Article Abstract:

Patients with small inoperable hepatocellular liver cancers and cirrhosis may be successfully treated by liver transplantation. Surgeons performed liver transplants in 48 patients with inoperable cancers consisting of either single tumors no larger than 5 centimeters in diameter or no more than three tumors of less than 3 centimeters diameter and who had no cancerous invasion of blood vessels or lymph nodes. Follow-up time averaged 26 months and ranged from 9 to 54 months. Although eight patients died after transplantation, only two died of recurrent cancer. This calculates to a actuarial four-year survival rate of 75% and recurrence-free survival rate of 83%. The three-year survival rate of untreated early hepatocellular liver cancer is 25%. Examination of the cancerous livers revealed that 13 patients had larger tumors than estimated. These patients had a four-year survival rate of only 50% and a recurrence-free survival rate of 59%.

Care and treatment, Liver cancer

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