title: Comparison between two high-dose methylprednisolone schedules in the treatment of acute hepatic cellular rejection in liver transplant recipients: a controlled clinical trial.
abstract: Intravenous methylprednisolone is used in most liver transplant centers as first-line therapy of acute hepatic cellular rejection in patients who undergo liver transplant. However, no controlled study has been performed to date to define the optimal dose and duration of the steroid regimen. The schedules that actually are used in most transplant centers are drawn from those that were developed empirically for the treatment of acute renal graft rejection. Thus, the aim of the study was to compare two schedules of steroid treatment of acute hepatic cellular rejection among those most widely used. Thirty-eight eligible patients with grade II or III acute hepatic cellular rejection were randomized to receive two different high-dose methylprednisolone schedules. Eighteen patients were randomized in group A (intravenous dose of 1,000 mg of methylprednisolone followed by a 6-day taper from 200 to 20 mg/d). Twenty patients were randomized in group B (intravenous dose of 1,000 mg of methylprednisolone for three consecutive days). The response to treatment was evaluated by means of a second liver biopsy. The treatment of group A proved to be more effective than treatment of group B. The resolution of acute hepatic cellular rejection was observed in 83.3% of cases in group A and 50.0% of cases in group B (P <.05). The treatment of group A proved to be safer also than treatment of group B. Patients randomized in group B showed a higher prevalence of infections (90.0% of cases versus 55.5% of cases; P <.01) mainly because of bacterial (80.0% versus 50.0%; P <.05) and viral (50.0% versus 16.6%; P <.05) agents. In conclusion, the study shows that intravenous administration of 1,000 mg of methylprednisolone followed by a 6-day taper from 200 to 20 mg/d is more effective and safer than intravenous dose of 1,000 mg of methylprednisolone for three consecutive days in the treatment of acute cellular rejection in patients with liver transplantation.
authors.affiliation: Department of Clinical and Experimental Medicine, University of Padua, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Volpin
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
authors.forename: Alessandra
authors.initials: A
authors.lastname: Galioto
authors.forename: Silvano
authors.initials: S
authors.lastname: Fasolato
authors.forename: Daniele
authors.initials: D
authors.lastname: Neri
authors.forename: Franco
authors.initials: F
authors.lastname: Barbazza
authors.forename: Roberto
authors.initials: R
authors.lastname: Merenda
authors.forename: Franco
authors.initials: F
authors.lastname: Del Piccolo
authors.forename: Mario
authors.initials: M
authors.lastname: Strazzabosco
authors.forename: Fabio
authors.initials: F
authors.lastname: Casagrande
authors.forename: Paolo
authors.initials: P
authors.lastname: Feltracco
authors.forename: Antonietta
authors.initials: A
authors.lastname: Sticca
authors.forename: Carlo
authors.initials: C
authors.lastname: Merkel
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gerunda
authors.forename: Angelo
authors.initials: A
authors.lastname: Gatta
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000704:Analysis of Variance; D001663:Bilirubin / Q000097:blood; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006084:Graft Rejection / Q000188:drug therapy*; D006801:Humans; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D014184:Transplantation, Homologous
chemical_list: D005938:Glucocorticoids; D000410:Alanine Transaminase; D001663:Bilirubin; D008775:Methylprednisolone