title: Complications in immunosuppressive therapy of liver transplant recipients.
abstract: BACKGROUND
  In liver transplantation (LT), modern immunosuppressive protocol is focused on early corticosteroid (CS) weaning. The aim of the study was to investigate all early transplant-related complications using Clavien grading system, in order to identify a significant relation in two homogenous groups of consecutive liver transplanted patients, only different for steroid avoidance in immunosuppressive regimen.
  
  
  METHODS
  One group was treated with a tacrolimus-based CS-free immunosuppressive protocol, the other one underwent tacrolimus plus low dose CS therapy. The preoperative continuous variables analyzed were age, gender, model for end-stage liver disease (MELD) score, and the pre-allocation score for predicting survival following liver transplantation (P-SOFT).
  
  
  RESULTS
  There were 39 patients in Group A (CS free) (37.9%), and 64 patients in Group B (CS on board) (62.1%). No statistically significant differences between the two groups were detected regarding the incidence and Clavien grade of complications (P = 0.116). No significant relation was revealed between Clavien rate of complications and tacrolimus-based CS-free immunosuppressive protocol, comparing the two subgroup of patient with P-SOFT score < 6 and ≥ 6 (P = 0.193). This association was noted comparing the two subgroups on tacrolimus plus low dose CS regimen (P = 0.013).
  
  
  CONCLUSIONS
  In this series, the use of CS in sick patient is associated with higher morbidity identified by the Clavien classification.
authors.affiliation: Istituto Mediterraneo Trapianti e Terapie ad Alta Specializzazione, University of Pittsburgh Medical Center in Italy, Palermo, Italy. sgruttadauria@ismett.edu
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gruttadauria
authors.forename: Fabrizio
authors.initials: F
authors.lastname: di Francesco
authors.forename: Duilio
authors.initials: D
authors.lastname: Pagano
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vizzini
authors.forename: Davide
authors.initials: D
authors.lastname: Cintorino
authors.forename: Marco
authors.initials: M
authors.lastname: Spada
authors.forename: Fabio
authors.initials: F
authors.lastname: Tuzzolino
authors.forename: Bruno
authors.initials: B
authors.lastname: Gridelli
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D000368:Aged; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000276:immunology / Q000401:mortality; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D016559:Tacrolimus / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D016559:Tacrolimus