Rapid steroid taper and neoral monotherapy in liver transplantation in Chile: A step in the right direction?

Innocenti, F.; Hepp, J; Humeres, Roberto; Sanhueza, Edgar; Zapata, Rolando Mendívil; Ríos, Horacio; Suarez, Laura; Sandoval, Rossy; Rius, M.; Zamboni, Mauro

doi:10.1016/j.transproceed.2004.06.063

Cited by 4 publications

(8 citation statements)

References 8 publications

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“…Early steroid-withdrawal regimens do not increase the rejection rate [7][8][9][10][11] . Padbury [12] has reported that, when steroids were withdrawn safely in 140/197 patients (71%), the acute and chronic rejection rate was 4.5 and 3.9%, respectively, and this was similar to the reported rates with steroid-containing regimens.…”

Section: Discussionmentioning

confidence: 98%

Early steroid withdrawal after liver transplantation for hepatocellular carcinoma

Chen

He²,

Zeng³

et al. 2007

WJG

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AIM:To evaluate the impact of early steroid withdrawal on the incidence of rejection, tumor recurrence and complications after liver transplantation for advancedstage hepatocellular carcinoma. METHODS:F i f ty-fo u r p a t i e n t s u n d e r w e n t l i ve r transplantation for advanced-stage hepatocellular carcinoma from April 2003 to June 2005. These cases were divided into a steroid-withdrawal group (group A, n = 28) and a steroid-maintenance group (group B, n = 26). In group A, steroid was withdrawn 3 mo after transplantation. In group B, steroid was continuously used postoperatively. The incidence of rejection, 6-mo and 1-year recurrence rate of carcinoma, 1-year survival rate, mean serum tacrolimus trough level, and liver and kidney function were compared between the two groups. RESULTS:In the two groups, no statistical difference was observed in the incidence of rejection (14.3 vs 11.5%, P > 0.05), mean serum tacrolimus trough levels (6.9 ± 1.4 vs 7.1 ± 1.1 µg/L, P > 0.05), liver and kidney function after 6 mo [alanine aminotransferase (ALT): 533 ± 183 vs 617 ± 217 nka/L, P > 0.05; creatinine: 66 ± 18 vs 71 ± 19 µmol/L, P > 0.05], 6-mo recurrence rate of carcinoma (25.0 vs 42.3%, P > 0.05), and 1-year survival rate (64.2 vs 46.1%, P > 0.05). The 1-year tumor recurrence rate (39.2 vs 69.2%, P < 0.05), serum cholesterol level (3.9 ± 1.8 vs 5.9 ± 2.6 mmol/L, P < 0.01) and fasting blood sugar (5.1 ± 2.1 vs 8.9 ± 3.6 mmol/L, P < 0.01) were significantly different. These were lower in the steroid-withdrawal group than in the steroidmaintenance group. CONCLUSION:Early steroid withdrawal was safe after liver transplantation in patients with advanced-stage hepatocellular carcinoma. When steroids were withdrawn 3 mo post-operation, the incidence of rejection did not increase, and there was no demand to maintain tacrolimus at a high level. In contrast, the tumor recurrence rate and the potential of adverse effects decreased significantly. This may have led to an increase in long-term survival rate.

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Section: Discussionmentioning

confidence: 98%

Early steroid withdrawal after liver transplantation for hepatocellular carcinoma

Chen

He²,

Zeng³

et al. 2007

WJG

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“…Nonetheless, whether combined with MMF or rapamycin, different centers adopted their own practices. 3,7 In a recent study, a steroid-free regimen with tacrolimus and MMF in liver transplants yielded good outcomes, with 86.7% and 83.9% 2-year patient and graft survival, and a 26.2% rejection rate, suggesting that it may be beneficial to use steroidfree immunosuppression combined with tacrolimus and MMF. 8 This study shows that steroid almost-avoidance could lead to minimization of immunosuppressive agents use, and prevention of steroid-related complications.…”

Section: Discussionmentioning

confidence: 99%

“…More and more clinicians support the early withdrawal of steroids aiming to minimize steroid-related morbility. [1][2][3] Based on our primary success in steroid withdrawal 3 months posttransplant, we attempted to evaluate the safety and efficacy of immunosuppressive regimen with steroid elimination within 24 hours in a cohort of Chinese liver transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

Twenty-Four Hour Steroid Avoidance Immunosuppressive Regimen in Liver Transplant Recipients

Guo²,

Xin³

et al. 2012

Exp Clin Transplant

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Objectives: To investigate the efficacy and safety of an immunosuppressive regimen of steroid avoidance in combination with induction therapy and tacrolimus in liver transplant recipients. Materials and Methods: Eighty-two adult liver transplant recipients were randomized into 2 groups: standard protocol group (n=41) in which steroids were withdrawn 3 months after the operation, and a 24-hour steroid avoidance group (n=41) in which steroids were eliminated within 24-hours. The incidence of acute rejections, infections (bacterial, fungal, and cytomegalovirus), and metabolic complications were analyzed between the groups. Results: The incidence of early posttransplant diabetes mellitus and the average dosage of insulin consumption among diabetic recipients were significantly higher in recipients in the standard protocol group than in the 24-hour avoidance group (P < .05). In addition, the incidence of hypertension and infection during the follow-up were also higher in patients of the standard protocol group (P < .05). The incidence of hypertension in the early posttransplant period, hyperlipemia, and acute rejection during the follow-up were comparable between the groups (P > .05).Conclusions: Twenty-four hour steroid avoidance combined with induction therapy and tacrolimus maintenance is a safe and efficient immunosuppression strategy that can significantly reduce posttransplant infections and other complications owing to long-term use of steroids, without increasing the risk of acute rejection.

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“…The pioneering liver transplantation of 1967 has been followed by wide acceptance of this modality to treat liver failure in children as well as adult patients. Increasingly, the long‐term complications of steroid‐induced post‐transplant diabetes mellitus, hypertension, growth retardation, weight gain, hypercholesterolemia, osteoporosis, and metabolic bone diseases demand non‐steroidal immunosuppressive treatment regimens (9). In the 1980s, cyclosporine A and in the 1990s, mycophenolate mofetil has been added as treatment with improved outcomes.…”

Section: Liver Transplantationmentioning

confidence: 99%

“…In the 1980s, cyclosporine A and in the 1990s, mycophenolate mofetil has been added as treatment with improved outcomes. Recently, rapid steroid taper and cyclosporine A monotherapy have shown results similar to the conventional slow steroid taper regimen, as measured by incidence and severity of allograft dysfunction (9). At one yr post‐transplant, the patient and the allograft survival rates showed no significant differences between the monotherapy group vs. the conventional treatment group.…”

Section: Liver Transplantationmentioning

confidence: 99%

Post‐transplant metabolic bone complications and optimization of treatment

Chan¹

2007

Pediatric Transplantation

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Rapid steroid taper and neoral monotherapy in liver transplantation in Chile: A step in the right direction?

Cited by 4 publications

References 8 publications

Early steroid withdrawal after liver transplantation for hepatocellular carcinoma

Early steroid withdrawal after liver transplantation for hepatocellular carcinoma

Twenty-Four Hour Steroid Avoidance Immunosuppressive Regimen in Liver Transplant Recipients

Post‐transplant metabolic bone complications and optimization of treatment

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