The Impact of Early Corticosteroid Withdrawal on Graft Survival in Liver Transplant Recipients

• Published in: Transplantation proceedings 2012-06, Vol.44 (5), p.1323-1328
• Main Authors: Meadows, H.B, Taber, D.J, Pilch, N.A, Tischer, S.M, Baliga, P.K, Chavin, K.D
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Adult; Biological and medical sciences; Chi-Square Distribution; Cross-Sectional Studies; Drug Administration Schedule; Drug Therapy, Combination; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Rejection - immunology; Graft Rejection - mortality; Graft Rejection - prevention & control; Graft Survival - drug effects; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Kaplan-Meier Estimate; Liver Transplantation - adverse effects; Liver Transplantation - immunology; Liver Transplantation - mortality; Male; Medical sciences; Middle Aged; Multivariate Analysis; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Risk Factors; South Carolina; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tissue, organ and graft immunology; Treatment Outcome
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2012.01.110

Abstract Background There has been increased interest in recent years in reducing or eliminating steroids from the immunosuppression regimen of transplant recipients to reduce adverse effects associated with their use. The purpose of this study was to compare clinical outcomes between early versus late steroid withdrawal after liver transplant to determine the optimal duration of steroid use in this population. Methods This large-scale, retrospective analysis of liver transplants occurred at our institution between 2000 and 2009. Patients were excluded if they were 1 year. The early steroid withdrawal group had steroids eliminated by 3 months posttransplant; late steroid withdrawal patients had steroids withdrawn between 3 and 12 months posttransplant. Results A total of 586 liver transplants occurred during the study period; 330 patients were included in the analysis. Graft survival was significantly lower in the early steroid withdrawal group. There was no difference in patient survival or overall acute rejection. However, the late steroid withdrawal group had a significantly higher rate of early acute rejection episodes. There was no difference with regard to new-onset diabetes after transplant, hyperlipidemia, or cardiovascular events between groups. Conclusion The results of this study suggest that late corticosteroid withdrawal is associated with better long-term graft survival without increasing the rates of diabetes, hyperlipidemia, or cardiovascular events in liver transplant recipients. A prospective study is warranted to confirm these findings.