Influence of steroids on HCV recurrence after liver transplantation: A prospective study.
OBJECTIVE
To assess the effect of long-term maintenance of steroids on HCV recurrence after liver transplantation (LT), that is still controversial, a prospective multicentre trial was conducted at the centres of Bologna and Padua, Italy.


METHODS
From September 2002, 47 eligible HCV positive LT recipients were randomized to receive 2 different steroid schedules in association with tacrolimus: group A: rapid tapering and withdrawal 91 days after LT group B: slow tapering and withdrawal 25 months after LT. Thirty-nine patients were assessable: 23 in group A and 16 in group B. Donor and recipient characteristics were similar in the two groups. Median follow-up was 841 days (130-1376). One hundred liver biopsies were performed, and every patient had a biopsy at month 12.


RESULTS
Twenty-two out of 23 (95, 65%) patients in group A and 15 out of 16 (93, 75%) in group B had histologically-confirmed HCV recurrence. Twelve-month histology showed advanced fibrosis (score 3 or 4) in 42.1% of the patients in group A versus 7.6% in group B (P=0.03). One-and 2-year advanced fibrosis-free survival were 65.2 and 60.8 in group A and 93.7% in group B (P=0.03 and =0.02, respectively).


CONCLUSIONS
Slow tapering of steroids reduced the progression of recurrent hepatitis C after LT.
Vivarelli
Marco
M
Department of Surgery and Transplantation, University of Bologna, Italy. vivarelli@aosp.bo.it
Burra
Patrizia
P
La Barba
Giuliano
G
Canova
Daniele
D
Senzolo
Marco
M
Cucchetti
Alessandro
A
D'Errico
Antonia
A
Guido
Maria
M
Merenda
Roberto
R
Neri
Daniele
D
Zanello
Matteo
M
Giannini
Federico Maria
FM
Grazi
Gian Luca
GL
Cillo
Umberto
U
Pinna
Antonio Daniele
AD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006526:Hepatitis C / Q000188:drug therapy* / Q000209:etiology* / Q000401:mortality; D006801:Humans; D008103:Liver Cirrhosis; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D055502:Secondary Prevention; D013256:Steroids / Q000627:therapeutic use*; D016896:Treatment Outcome
D013256:Steroids; D011241:Prednisone