Pre-transplant UDCA and post-transplant outcomes

The retrieved evidence does not establish that pre-transplant ursodeoxycholic acid (UDCA) improves post-transplant outcomes in PSC; meta-analyses show no significant effect on transplant-free survival, and UDCA has not shown an impact on the incidence of recurrent PSC after transplant ^1,2. A beneficial long-term effect of UDCA on solid clinical endpoints in native PSC has not been established ². ^1–4

What is known:

• Meta-analyses have shown no significant effect of UDCA on transplant-free survival, and its use post-transplant has not shown an impact on the incidence of recurrent PSC. ¹
• A population-based cohort notes that a beneficial long-term effect of UDCA on solid clinical endpoints in PSC has not yet been established. ²
• High-dose UDCA has been associated with increased adverse outcomes in early-stage PSC and with development of colorectal neoplasia in patients with ulcerative colitis and PSC. ^3,4

What is unknown / caveats:

• Some cohort studies report UDCA associated with improved long-term outcome in PSC ⁴, whereas meta-analyses and other cohorts find no benefit on transplant-free survival ^1,2
• The excerpts address UDCA in native PSC and post-transplant recurrence but do not directly evaluate PRE-transplant UDCA exposure as a predictor of post-transplant outcomes
• Citations are largely reference lists and abstracts rather than full results
• The excerpts do not isolate the specific question of pre-transplant UDCA use and its effect on subsequent graft or survival outcomes.

References

1. Becchetti C, Viganò R, Aprile F, Scaravaglio M, Vitale G, Perricone G, Mazzarelli C, Vangeli M, Belli LS, Carbone M, Morelli MC. Beyond the Graft: Optimizing Post-Transplant Care in Primary Sclerosing Cholangitis. J Clin Med. 2026. PMID: 42123212.

2. Mol B, van Munster K, Weersma R, Inderson A, Boonstra K, Drenth J, van Meer S, de Vries E, Spanier M, Vrij A, Verlaan T, van Duijn F, Ponsioen W, Dijkgraaf M, Ponsioen C, EpiPSC2 study G. The longstanding issue of the benefit of ursodeoxycholic acid in primary sclerosing cholangitis: a long-term population-based study. J Gastroenterol. 2026. PMID: 42298049.

3. Ali AH, Carey EJ, Lindor KD. Current research on the treatment of primary sclerosing cholangitis. Intractable Rare Dis Res. 2015. PMID: 25674381.

4. Frolkis AD, Nayagam JS, Parente A, Seager M, Sadler MD, Montano-Loza AJ, Joshi D. Evaluation and management of primary sclerosing cholangitis patients awaiting liver transplantation. JHEP Rep. 2026. PMID: 41825099.

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Draft, generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct.