Slowly tapering off steroids protects the graft against hepatitis C recurrence after liver transplantation

Abstract

Chronic hepatitis C represents a major clinical problem after liver transplantation, but factors influencing the recurrent disease have not been well characterized. We analyzed the clinical records of all the patients transplanted for hepatitis C virus (HW-related liver disease in our Center between 1991 and 1997. Eighty consecutive HCV-positive (+) patients (60 men, ages 28 to 64) survived more than 1 month after transplantation and were followed for a median of 45 months. Diagnosis of recurrent chronic hepatitis C was made in 38 patients (47.5%), of whom 22 had moderate/severe chronic hepatitis. Decompensated cirrhosis occurred in six patients (7.5%).N o difference in patient survival was found between patients with and without hepatitis C recurrence. N o association was found between recurrent hepatitis C and presumed risk factors. The method of tapering off corticosteroids was significantly associated with both hepatitis C recurrence and the severity of hepatitis. In patients receiving a higher daily prednisone dose, 12 months after transplantation, the proportion of recurrent hepatitis C was The aim of our study was to evaluate the clinical records of all patients who underwent transplantation in our single center during the last decade to outline the features of recurrent hepatitis C and, possibly, to identi!+ the risk factors eventually associated with the more severe forms of this disease. 35 Patients and Methods Patient PopulationBetween January, 1991 and December, 1997, 25 1 adult patients underwent OLT at the Department of Surgery and Transplantation, University of Bologna, ofwhom 97 received liver graft for end-stage liver disease secondary to HCV infection. Of these patients, 12 with a concomitant hepatitis B virus (HBV) infection, one with de novo HBV infection after OLT, and four who died within 30 days after surgery were excluded from the analysis. Therefore, our study population included 80 consecutive patients (60 men and 20 women, ages ranging from 28 to 64 years), who underwent transplatation for HCV-related liver disease, who survived more than 1 month after OLT, with well-established HCV infection (anti-HCV and HCV-RNA positivity by polymerase chain reaction) before and after after liver transplant, Clinical and laboratory data were available for the complete series of patients at the time of transplantation and subsequently.

Current Status of Immunosuppression in Liver Transplantation

“…20 For hepatitis C, role of low dose steroids with slow taper is advocated by some studies [85][86][87] Most centers would continue prolonged low dose steroids in patients transplanted for autoimmune liver diseases. 20 …”

The role of immunosuppression in recurrence of hepatitis C

“…However, there also is evidence that withdrawal of corticosteroids may be harmful to HCV-infected patients undergoing liver transplantation. 12 Similarly, data for mycophenolate mofetil (MMF) are confusing. One study from Berlin showed that if MMF is added to the posttransplantation regimen, there is no change in HCV RNA levels or severity of disease (Fig.…”

Impact of immunosuppression on immunopathogenesis of liver damage in hepatitis C virus-infected recipients following liver transplantation

“…Thus, patients who had their CS dose tapered slower had less tissue damage. 34 In this study, five of six patients with decompensated cirrhosis were in the group with more rapid tapering of steroid therapy.…”