Long-term immunosuppression after liver transplantation: are steroids necessary?
Steroid therapy was withdrawn in 85% of 152 orthotopic liver transplant recipients with grafts surviving for more than 3 months, and 87% of these remained steroid-free. Steroid therapy was restarted in 8% for reasons other than rejection. The most common was conversion of immunosuppression because of cyclosporine nephrotoxicity. The incidence of rejection after steroid withdrawal was low: 3.8% for chronic rejection (CR) and 4.5% for acute rejection. Only 3 grafts (1.9%) were lost because of CR. No risk factors have been identified for the development of CR after steroid withdrawal, but a protective role for azathioprine has been suggested.
Padbury
R T
RT
The Liver Unit, Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom.
Gunson
B K
BK
Dousset
B
B
Hubscher
S G
SG
Mayer
A D
AD
Buckels
J A
JA
Neuberger
J M
JM
Elias
E
E
McMaster
P
P
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D002908:Chronic Disease; D016572:Cyclosporine / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000276:immunology*; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D015203:Reproducibility of Results; D012307:Risk Factors; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone