Steroids in intestinal transplantation.
BACKGROUND
Recently, new immunosuppressive protocols after intestinal transplantation have been proposed to avoid steroids use and their adverse effects. We evaluated the impact of steroids on survival and post-transplant complications in our experience.


METHODS
In our retrospective study we considered the mean daily dosage of steroids received by 25 patients after intestinal/multivisceral transplantation (minimal follow-up was six months). We analyzed graft and patient survival rates, correlation with rejection and infectious episodes and steroids side effects.


RESULTS
After a mean follow-up of three yr, we did not find any significant difference in steroid doses between our immunosuppressive protocols. Patients with a mean dosage of prednisone higher than 20 mg/d experienced a lower graft (p = 0.009) and patient (p = 0.02) survival rate. The side effects of steroids after transplant were similar. Infections were more frequent during steroids administration (p = 0.04).


CONCLUSIONS
Steroids therapy may be useful to treat acute rejection, but in our experience high steroids regimen did not improve graft and patient survival, increasing infectious rate. We assumed that high dose of steroids can be avoided as maintenance therapy, except in selected cases.
Dazzi
A
A
UO Chirurgia dei Trapianti di Fegato e Multiorgano, University of Bologna, Bologna, Italy.
Lauro
A
A
Zanfi
C
C
Ercolani
G
G
Vivarelli
M
M
Grazi
G L
GL
Cescon
M
M
Di Simone
M
M
D'Errico
A
A
Lazzarotto
T
T
Faenza
S
S
Pironi
L
L
Pinna
A D
AD
D000328:Adult; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007422:Intestines / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation / Q000401:mortality; D011241:Prednisone / Q000008:administration & dosage; D014781:Viscera / Q000637:transplantation
D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D011241:Prednisone