The optimal calcineurin inhibitor after liver transplantation (LT) for primary biliary cholangitis (PBC) remains debated. We compared tacrolimus with cyclosporine in a propensity score–matched intention-to-treat analysis from the Scientific Registry of Transplant Recipients. We included adults with PBC who underwent primary LT from 1995 to 2022. Patients with initial cyclosporine treatment were 1:3 matched with those with initial tacrolimus treatment, ensuring exact calendar-period match. Primary outcomes were patient and graft survival. After matching, 579 patients with PBC and initial cyclosporine and 1348 with tacrolimus were well balanced for baseline characteristics. During a median follow-up of 11.1 years, 1044 (54%) deaths and 124 (6%) re-LTs occurred. In the overall matched sample, no significant survival difference emerged between cyclosporine and tacrolimus. However, tacrolimus conferred a survival advantage in some secondary analysis, such as LT after year 2000 and women, and in a 6-month landmark analysis excluding early postoperative events and calcineurin inhibitor switches. Cyclosporine did not reduce graft loss from PBC recurrence or affect laboratory markers of recurrence. In conclusion, we found no benefit of starting immunosuppression with cyclosporine after LT for PBC.

中文翻译：

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肝移植后环孢素和他克莫司治疗原发性胆汁性胆管炎的比较：倾向评分匹配的意向治疗登记研究


肝移植 （LT） 后治疗原发性胆汁性胆管炎 （PBC） 的最佳钙调磷酸酶抑制剂仍存在争议。我们在来自移植受者科学登记处的倾向评分匹配的意向治疗分析中比较了他克莫司与环孢菌素。我们纳入了 1995 年至 2022 年接受初次 LT 的 PBC 成人患者。初始环孢素治疗的患者与初始他克莫司治疗的患者按 1：3 的比例匹配，确保确切的日历周期匹配。主要结局是患者和移植物存活率。匹配后，579 例 PBC 和初始环孢素患者以及 1348 例他克莫司患者的基线特征平衡良好。在中位随访 11.1 年期间，发生了 1044 例 （54%） 死亡和 124 例 （6%） 再 LT。在总体匹配样本中，环孢菌素和他克莫司之间没有出现显着的生存差异。然而，他克莫司在一些二次分析中具有生存优势，例如 2000 年后的 LT 和女性，以及排除术后早期事件和钙调神经磷酸酶抑制剂转换的 6 个月标志分析。环孢素不能减少 PBC 复发引起的移植物损失或影响复发的实验室标志物。总之，我们发现在 LT 后开始使用环孢素进行免疫抑制治疗 PBC 没有益处。