Liver transplantation is a major surgical procedure that has been practiced for more than forty years and has nowadays become a generally accepted treatment option in patients with end-stage liver disease. The most common cause for liver transplantation in adults is cirrhosis caused by various types of liver injuries such as infections (hepatitis B and C), alcohol, autoimmune liver diseases, early-stage liver cancer, metabolic and hereditary disorders, but also diseases of unknown aetiology. All transplant recipients need lifetime immunosuppressive therapy to prevent transplant rejection.
Bile acids are being used for a variety of chronic liver diseases, mainly primary biliary cirrhosis and primary sclerosing cholangitis. However, their mechanisms of action and beneficial and harmful effects are poorly understood. This has led to the idea of the potential use of bile acids to prevent rejection in liver-transplanted patients.
Results of the seven randomised clinical trials included in the review in which patients received standard immunosuppressive treatment (steroids, azathioprine, and cyclosporine or tacrolimus) with or without bile acids after liver transplantation, did not show any significant effects of bile acids on all-cause mortality, mortality related to rejection, acute cellular rejection, steroid resistant rejection, or need for retransplantation. One analysis suggested that bile acids might beneficially influence number of patients with chronic rejection, but was contradicted by the analyses. The evidence that the use of ursodeoxycholic acid might have beneficial effects on chronic rejection and length of hospitalisation is weak as it is produced from trials with high risk of bias and insufficient number of included patients. That bile acids seemed well tolerated, with no reports of serious adverse events, is good knowledge, but much more research is needed before their use is acquitted. None of the randomised clinical trials assessed the effects of bile acids on quality of life or cost-effectiveness.