*Purpose: Endogenous bile acids are suspected to contribute to hepatobiliary injury after liver transplantation through direct cytotoxic effects. Ursodeoxycholic acid (UDCA) has been shown to increase bile flow, decrease liver enzymes and incidence of biliary casts in the early post-operative period. Studies assessing the long-term effect of UDCA post-transplant remain limited. The purpose of this study was to evaluate the effects of long-term ursodiol in post liver transplant patients.

*Methods: We performed a retrospective evaluation of patients with liver transplant between 5/2014- 10/2016 at a single center. Patients with primary biliary cirrhosis, primary sclerosing cholangitis and autoimmune hepatitis were excluded. A total of 284 patients were evaluated for data including demographics, operative factors, reason for transplantation, UDCA use at 6 months, 12 months, 24 months and 36 months and dosage, hospitalizations, biliary strictures or leaks and mortality. Statistics were calculated using analysis of variance (ANOVA), chi-square, Fisher’s exact test and Wilcoxon Rank Sum Test.

*Results: 284 liver transplants were performed in 180 males and 104 females with a mean age of 57.5. Ursodiol was taken by 62% of patients at 6 months post transplant, 55% at 12 months, 45.4% at 2 years and 26.8% at 3 years. Patients with history of early biliary complications were more likely be to be on ursodiol at 6 months (84.7 vs 61.8%), 12 months (84.7 vs 52.5%), 24 months (70.2% vs 45.5%) and 36 months (61.0% vs 35.9%) post transplant (p<0.001). Patients with or without ursodiol at all time points had no significant differences in rates of late biliary complications. At one year, there was no significant difference in ursodiol use (59.3% vs 59.1%, p=0.982) in those who died within 3 years post transplant versus those who survived, there was no significant difference in ursodiol use (55.1% vs 62.8%, p=0.208) in those who required multiple hospitalizations and there was no significant difference in ursodiol use (57.4 vs 63.8%, p=0.333) in those who had a history of early or late rejection. There was no significant difference at 6 months, 24 months or 36 months in requiring rehospitalization or rejection.

*Conclusions: Our study showed that a large percentage of patients remained on long term ursodiol at our center following liver transplantation. This study demonstrates no long-term benefit of this long term UDCA use on mortality, re-admission rates or rejection rates post-transplant. Patients with history of biliary complication were more likely to be on long term UDCA therapy. This study suggests that UDCA does not have long term protective effect. Given these findings, further prospective studies are needed to clarify if there is any benefit at all in the long term use of ursodiol following liver transplant.

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