Steroid‐free immunosuppression during and after liver transplantation – a 3‐yr follow‐up report

Abstract

Steroids are not necessary in more than 50% of liver transplantations. Steroids were transiently needed to treat acute rejection in 23.5% liver transplantations and for toxicity of calcineurin inhibitors or azathioprine or other reason in 28%. Of the patients who received steroids, the majority (70%) was eventually taken off steroids. This prospective single-center pilot study shows that liver transplantation without steroids is feasible and yields no penalty in terms of acute and chronic rejection, immune graft loss, graft function, patient and graft survival.

Early steroid withdrawal after liver transplantation for hepatocellular carcinoma

“…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 Padbury [12] has reported that, when steroids were withdrawn safely in 140/197 patients (71%), the acute and chronic rejection rate was 4.5 and 3.9%, respectively, and this was similar to the reported rates with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.…”

Preoperative Glucocorticoid Use in Major Abdominal Surgery

“…administration on anastomotic leaks in colorectal surgery was examined using the PETO odds ratio method as anastomotic leaks were anticipated to be rare events. 21 Medians were converted to means using the technique described by Hozo et al 31 Forest plots were then constructed with P < 0.05 considered statistically significant. Statistical heterogeneity was evaluated using I 2 statistics and a χ 2 test for heterogeneity was performed, with P < 0.1 regarded as statistically significant.…”

“…20 GCs have also been used for immunosuppression in liver transplantation and may improve postoperative outcomes. 13,[21][22][23] However, their safety and efficacy has not been established in major elective abdominal surgery with concerns regarding potential increases in infectious complications. 10 Moreover, GCs cause hyperglycaemia which is now known to be associated with an exaggerated catabolic response and increased complications.…”

Steroid immunosuppression in kidney transplantation: a passing era

“…Moreover, chronic steroid use likely is not necessary for other abdominal organ transplants either. Reports of steroid-free immunosuppression have been published for pediatric recipients of kidney [44] and liver [45] transplants, adult recipients of liver allografts [46], and recipients of pancreas transplants [47,48], further supporting this position.…”