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

Abstract

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adult liver transplant recipients were randomized into 2 groups: standard protocol group (n=41) in which steroids were withdrawn 3 months after the operation, and a 24-hour steroid avoidance group (n=41) in which steroids were eliminated within 24-hours.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.

Allografts Positive for Hepatitis B Surface Antigen in Liver Transplant for Disease Related to Hepatitis B Virus

“…[18][19] The present study also confirmed that discontinuing steroids early after liver transplant is a safe and effective immunosuppression strategy without increasing the frequency of acute rejection. [20][21][22][23] In the present study, we used basiliximab induction and a steroid-sparing immunosuppressive regimen (mycophenolate mofetil and tacrolimus), which was associated with a low incidence of acute rejection; only 1 of 23 patients had acute rejection, similar to that previously reported, and this was reversed by large doses of steroid therapy. 24 In the present study, 2 patients died of perioperative pulmonary infection, and 3 patients died of tumor recurrence.…”

Impact of different immunosuppressive regimens on the health‐related quality of life following orthotopic liver transplantation

“…These drugs have been in long use, and their benefit in prevention of graft rejection in OLT is well‐established. Their safety has also been proven . However, immunosuppressants, by definition, cause numerous side effects with gastrointestinal symptoms, deterioration of kidney function, arterial hypertension, diabetes, and osteoporosis .…”

Efficacy and Safety of a Steroid-Free Immunosuppressive Regimen after Liver Transplantation for Hepatocellular Carcinoma

“…No differences were found in the incidence of hypertension and hyperlipidemia between the steroid early avoidance and standard groups. 19 In another study, the incidence of hypertension, hyperglycemia, and DM were significant lower in steroid-free recipients, 20 demonstrating that the effect of steroids on metabolic complications are still controversial.…”