Liver Transplantation 

• Liver transplantation is the only life-saving procedure for patients with progressive PBC and consequent liver failure
  • Increasing bilirubin and decreasing albumin levels and a prolonged prothrombin time are signs of disease progression
• A referral for a liver transplant evaluation should be done in patients with decompensated cirrhosis, total bilirubin >6 mg/dL, a MELD score of at least 15 and >7.8 from the updated Mayo Clinic Natural History Model for PBC 
• Consider liver transplantation in refractory ascites, recurrent spontaneous bacterial peritonitis, recurrent variceal bleeding, hepatic coma, HCC or hepatorenal syndrome type I
  • Uncontrollable pruritus resistant to medical therapy may be an indication for liver transplantation
• Patients with PBC recurrence post liver transplant can be given UDCA therapy