Ursodeoxycholic acid treatment in isolated chronic graft-vs.-host disease of the liver

• Published in: Clinical transplantation Vol. 19; no. 6; pp. 798 - 803
• Main Authors: Arat, Mutlu, Idilman, Ramazan, Soydan, Ender Akcaglayan, Soykan, Irfan, Erden, Esra, Karayalçın, Selim, Akan, Hamdi
• Format: Journal Article
• Language: English
• Published: Oxford, UK Munksgaard International Publishers 01.12.2005; Blackwell
• Subjects: Adolescent; Adult; allogeneic hematopoietic cell transplantation; Aspartate Aminotransferases - blood; Bilirubin - blood; Biological and medical sciences; Cholagogues and Choleretics - therapeutic use; cholestatic liver diseases; chronic graft-vs.-host disease; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; gamma-Glutamyltransferase - blood; Graft vs Host Disease - drug therapy; Hematopoietic Stem Cell Transplantation; Humans; Liver Diseases - drug therapy; Male; Medical sciences; Middle Aged; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Transplantation Conditioning; ursodeoxycholic acid; Ursodeoxycholic Acid - therapeutic use; Disease; Stem cell; Hematopoietic cell; Homograft; Hepatic disease; cholestatic liver diseases; Host; Transplantation; Ursodeoxycholic acid; allogeneic hematopoietic cell transplantation; Medicine; Chronic; Treatment; chronic graft-vs.-host disease; Bile acid; Surgery; Digestive diseases; Graft; Comparative study
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/j.1399-0012.2005.00424.x

:  Objectives:  Data regarding the long‐term treatment of ursodeoxycholic acid (UDCA) in individuals of chronic graft‐vs.‐host disease (cGVHD) of the liver are limited. The aims of this prospective study were to determine whether, (i) UDCA treatment is useful as a long‐term treatment for individuals with limited cGVHD of the liver following allogeneic hematopoietic cell transplantation, and (ii) the tolerability of UDCA treatment in such individuals. Methods:  Fifteen consecutive patients with de novo isolated cGVHD of the liver were included. All individuals were treated with UDCA at a dose of 13 mg/kg/d for 1 yr. Clinical evaluation and laboratory testing were assessed at 30‐d intervals during UDCA therapy and every 30 d after discontinuation of UDCA for a total of 3 months. Results:  At the end of the treatment, 60% of patients with cGVHD of the liver had normal liver tests, the remaining 40% of patients demonstrated improvement in their abnormal liver tests (partial responders), whereas none of the patients had worsening of the liver tests. When compared with baseline, there was a significant decrease in the serum aminotransferases, alkaline phosphatase and gamma‐glutamyl transpeptidase levels after completion of the UDCA treatment at 12 months (p < 0.01). No significant increase in serum liver enzyme tests was observed at the third month after the completion of therapy. Pruritus in seven of nine patients resolved after UDCA treatment. All patients completed their assigned treatment with no major adverse event. Conclusion:  Long‐term UDCA therapy appears to be effective, safe and tolerable in individuals with cGVHD presenting with isolated liver involvement.