Primary Biliary Cholangitis, Liver Transplantation, and Hepatocellular Carcinoma: A Mini-review

Primary biliary cholangitis (PBC) is an organ-specific chronic autoimmune disease characterized by T-lymphocyte mediated destruction of intrahepatic biliary epithelial cells due to a combination of genetic and possible environmental factors. PBC progresses to hepatic fibrosis and cirrhosis, with the potential of developing hepatocellular carcinoma (HCC) if left untreated. PBC is more common in middle-aged women. It is diagnosed in patients with elevated liver enzymes and the serological hallmark of antimitochondrial antibody (AMA). Early diagnosis and treatment are crucial in improving survival and preventing long-term complications of liver disease. Ursodeoxycholic acid (UDCA) is first-line treatment for PBC. Obeticholic acid (OCA) and fibrates, in combination with UDCA or as monotherapy, may be given to PBC patients with partial or no UDCA response. Liver transplantation has thus been indicated in patients with decompensated cirrhosis or unresectable HCC.