{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T09:42:49Z","timestamp":1784799769743,"version":"3.55.0"},"reference-count":26,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T00:00:00Z","timestamp":1663804800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>After 1\u2009year of ursodeoxycholic acid (UDCA), patients with primary biliary cholangitis (PBC) may have a normal GLOBE score despite high alkaline phosphatase (ALP) levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To assess the association between ALP and liver transplantation (LT)\u2010free survival according to the GLOBE score<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Among patients with a normal or elevated GLOBE score in the Global PBC cohort, the association between ALP after 1\u2009year of UDCA and the risk of LT\/death was assessed. The LT\u2010free survival was compared with that of a matched general population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>After 1\u2009year of UDCA, ALP was associated with the risk of LT\/death (aHR 1.31, 95% CI 1.003\u20131.72, <jats:italic>p<\/jats:italic>\u00a0=\u20090.048) among 2729 patients with a normal GLOBE score. The 10\u2010year LT\u2010free survival among these patients with an ALP\u2009&gt;2.0\u00a0\u00d7\u2009ULN was 94.0% (95% CI 90.1\u201397.9) for those &lt;50\u2009years, and 82.6% (95% CI 76.5\u201388.7) for those \u226550\u2009years, which was significantly lower (<jats:italic>p<\/jats:italic>\u00a0=\u20090.040) and similar (<jats:italic>p<\/jats:italic>\u00a0=\u20090.736) to that of the matched population, respectively. The 10\u2010year LT\u2010free survival in patients \u226550\u2009years with normal GLOBE score and normal ALP (90.8%, 95% CI 87.7\u201393.9) was significantly higher (<jats:italic>p<\/jats:italic>\u00a0=\u20090.022) than the matched population. Among 1045 patients with an elevated GLOBE score, ALP was associated with LT\/death only in those &lt;50\u2009years (aHR 1.38, 95% CI 1.06\u20131.81, <jats:italic>p<\/jats:italic>\u00a0=\u20090.016).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The LT\u2010free survival of patients with\u00a0PBC with a normal GLOBE score is optimal in case of normal ALP levels, also in relation to the general population. Despite their generally favourable prognosis, an elevated ALP level may still indicate a need for add\u2010on therapy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.17226","type":"journal-article","created":{"date-parts":[[2022,9,23]],"date-time":"2022-09-23T04:38:50Z","timestamp":1663907930000},"page":"1408-1418","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Liver transplant\u2010free survival according to alkaline phosphatase and <scp>GLOBE<\/scp> score in patients with primary biliary cholangitis treated with ursodeoxycholic acid"],"prefix":"10.1111","volume":"56","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1604-0931","authenticated-orcid":false,"given":"Rozanne C.","family":"de Veer","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology Erasmus University Medical Center  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5554-3286","authenticated-orcid":false,"given":"Maren H.","family":"Harms","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Erasmus University Medical Center  Rotterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christophe","family":"Corpechot","sequence":"additional","affiliation":[{"name":"Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, European Reference Network on Hepatological Diseases (ERN Rare\u2010Liver) Saint\u2010Antoine Hospital, Assistance Publique \u2010 H\u00f4pitaux de Paris; Inserm UMR_S938, Saint\u2010Antoine Research Center, Sorbonne University  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Thorburn","sequence":"additional","affiliation":[{"name":"The Sheila Sherlock Liver Centre, and UCL Institute of Liver and Digestive Health The Royal Free Hospital  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3262-1998","authenticated-orcid":false,"given":"Pietro","family":"Invernizzi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery University of Milano\u2010Bicocca  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harry L. A.","family":"Janssen","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver disease, Toronto General Hospital University Health Network  Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pier M.","family":"Battezzati","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Universit\u00e0 degli Studi di Milano  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederik","family":"Nevens","sequence":"additional","affiliation":[{"name":"Department of Hepatology University Hospitals Leuven  KU Leuven Leuven Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1046-5621","authenticated-orcid":false,"given":"Keith D.","family":"Lindor","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Mayo Clinic  Rochester Minnesota USA"},{"name":"Arizona State University College of Health Solutions  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annarosa","family":"Floreani","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology University of Padua  Padua Italy"},{"name":"Scientific Institute for Research Hospitalization and Healthcare  Negrar Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyriel Y.","family":"Ponsioen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Amsterdam University Medical Centres location Academic Medical Center  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4874-7010","authenticated-orcid":false,"given":"Marlyn J.","family":"Mayo","sequence":"additional","affiliation":[{"name":"Digestive and Liver diseases, UT Southwestern Medical Center  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Par\u00e9s","sequence":"additional","affiliation":[{"name":"Liver Unit Hospital Cl\u00ednic, CIBERehd, IDIBAPS, University of Barcelona  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0470-9522","authenticated-orcid":false,"given":"Andrew L.","family":"Mason","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kris V.","family":"Kowdley","sequence":"additional","affiliation":[{"name":"Liver Care Network and Organ Care Research Swedish Medical Center  Seattle WA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Palak J.","family":"Trivedi","sequence":"additional","affiliation":[{"name":"Birmingham NIHR Biomedical Research Centre, and Centre for Liver Research University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6736-2255","authenticated-orcid":false,"given":"Gideon M.","family":"Hirschfield","sequence":"additional","affiliation":[{"name":"Toronto Centre for Liver disease, Toronto General Hospital University Health Network  Toronto Canada"},{"name":"Birmingham NIHR Biomedical Research Centre, and Centre for Liver Research University of Birmingham  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5576-6914","authenticated-orcid":false,"given":"Tony","family":"Bruns","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine IV Jena University Hospital, Friedrich Schiller University  Jena Germany"},{"name":"Department of Internal Medicine III University Hospital RWTH Aachen  Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George N.","family":"Dalekos","sequence":"additional","affiliation":[{"name":"Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases General University Hospital of Larissa  Larissa Greece"},{"name":"European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER) General University Hospital of Larissa  Larissa Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos K.","family":"Gatselis","sequence":"additional","affiliation":[{"name":"Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases General University Hospital of Larissa  Larissa Greece"},{"name":"European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER) General University Hospital of Larissa  Larissa 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