Steroid-free immunosuppression after liver transplantation does not increase the risk of graft fibrosis.
BACKGROUND
Steroid-free immunosuppression after liver transplantation (OLT) is effective and safe in the short and mid terms. However, research has shown a higher risk for late fibrosis among pediatric liver transplant recipients who have steroids withdrawn. Our aim was to test this hypothesis in the adult population.


METHODS
The study involved 27 adults, 14 of whom were on a regimen of cyclosporine, azathioprine, and steroid (group A) and 13 cyclosporine and azathioprine steroid-free immunosuppression (group B). The main end point of the study was liver graft histology in the late stage after OLT, with emphasis on the evolution of fibrosis, which was scored according to Ishak. The secondary end points were patient and graft survivals, liver and kidney functions, rejection rates, infections, and tumors, as well as the incidences of cardiovascular and metabolic complications.


RESULTS
After a mean follow-up of 89.3 +/- 21 months, the mean fibrosis scores did not differ between the 2 groups (2.2 +/- 1.5 vs 1.9 +/- 1.2; P = NS). One group A patient developed a severe acute rejection episode. The 7-year patient and graft survivals, as well as liver and kidney functions, incidence of infections, and cardiovascular and metabolic complications were comparable. Patients receiving steroids showed a trend toward an higher rate of de novo malignancies.


CONCLUSIONS
Steroid-free immunosuppression did not increase the risk of graft fibrosis in the long term.
Manzia
T M
TM
Transplant Unit, Surgical Clinic, Department of Surgery, Tor Vergata University of Rome, S Eugenio Hospital, Rome, Italy. tomanzia@libero.it
Toti
L
L
Angelico
R
R
Di Cocco
P
P
Orlando
G
G
Tisone
G
G
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001379:Azathioprine / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000473:pathology; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology* / Q000401:mortality / Q000473:pathology; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D012449:Safety; D015996:Survival Rate; D017741:Survivors; D013997:Time Factors
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine; D000410:Alanine Transaminase; D001379:Azathioprine; D001663:Bilirubin