199Early ribavirin treatment and avoidance of steroids in HCV positive liver transplant candidates: Preliminary report of a prospective randomized trial

Pinzello, G; Belli, Luca; Alberti, Alberto; Airoldi, Aldo; Cermuschi, A; Rondinara, G. F.; DeCarlis, L.; Forn, D; DeGasperi, Andrea; Corti, A

doi:10.1016/s1527-6465(05)80227-8

Cited by 1 publication

(2 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[14][15][16] Previous attempts at complete steroid abstinence in OLT have had mixed results, with a significant number of patients subsequently requiring steroid treatment for rejection. [5][6][7][8] Tisone et al 6 randomized 45 patients to the administration of cyclosporine and azathioprine with or without steroids. The incidence of rejection was 60% in each group, with 10% of patients in each group subsequently being administered steroids for rejection.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Previous attempts at complete avoidance of steroid use in OLT have had mixed results, and none was able to maintain patients completely without steroids. [5][6][7][8] Thymoglobulin (Sangstat, Freemont, CA) is a polyclonal rabbit antithymocyte globulin (RATG) previously shown to be an effective immunosuppressive agent in OLT. [9][10][11] RATG in conjunction with steroids has been shown to effectively reduce the incidence of rejection in OLT without an increased incidence of infectious complications or malignancy.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Steroid-free liver transplantation using rabbit antithymocyte globulin induction: Results of a prospective randomized trial

Eason

Loss

Blazek

et al. 2001

Liver Transplantation

121

View full text Add to dashboard Cite

Steroids have been 1 of the primary modes of immunosuppression since the inception of transplantation and have been credited with both the prevention and treatment of rejection. Steroids also have been held responsible for increased infections, posttransplantation diabetes, and recurrent hepatitis after orthotopic liver transplantation (OLT). The purpose of this ongoing prospective randomized trial is to eliminate steroid use in OLT through induction with rabbit antithymocyte globulin (RATG). This is the first report of a prospective randomized trial in OLT achieving complete absence of steroids. Seventy-one adult patients were prospectively randomized to administration of RATG or steroids. Thirty-six patients were randomized to the administration of RATG induction at a dose of 1.5 mg/kg intravenously (IV) beginning during the anhepatic phase. No steroids were administered. Patients were administered a second 1.5-mg/kg dose of RATG post-OLT day 1. Thirty-five patients were randomized to the administration of methylprednisolone, which had been our standard immunosuppressive protocol. These patients were administered methylprednisolone, 1,000 mg IV, initiated during the anhepatic phase and followed by steroid taper. Maintenance immunosuppression consisted of tacrolimus and mycophenolate, with or without prednisone. Three patients died in each group, for an overall survival rate of 91% in each group. One patient in each group required re-OLT, for a graft survival rate of 89% in each group. Seven patients administered RATG had biopsy-proven rejection (20.5%), all of whom were successfully treated by increasing tacrolimus doses. Eleven patients administered steroid had biopsy-proven rejection (32%), 7 (64%) of whom required additional steroids for treatment, whereas 4 patients (36%) were successfully treated by increasing tacrolimus doses. The incidence of rejection was not statistically significant; however, there was a significant difference in the incidence of steroid-requiring rejection (P ‫؍‬ .01). The incidence of recurrent hepatitis C was 50% in RATG patients and 71% in steroid patients (P ‫؍‬ not significant). The incidence and severity of infectious complications were slightly lower in RATG patients, accounted for by a greater incidence of cytomegalovirus (CMV) infection in the steroid patients. RATG induction enables complete avoidance of steroid use in OLT with a trend toward a lower rejection rate, decreased incidence of post-OLT diabetes and recurrent hepatitis C, and decreased CMV infection. This prospective randomized trial gives encouraging support that steroids can be safely eliminated in OLT. (Liver Transpl 2001;7: 693-697.) S teroids have been a cornerstone of immunosuppression since the inception of transplantation and are credited with both the prevention and treatment of rejection. However, steroids have also been shown to increase infectious complications, bone disease, and posttransplantation diabetes and possibly increase the incidence and severity of recurrent hepatitis C virus (HCV) infecti...

show abstract