title: Steroid withdrawal in adult liver transplantation: occurrence at a single center.
abstract: BACKGROUND
  Steroids are the predominant immunosuppressive agent used after liver transplantation even though patients may experience steroid-related side effects.
  
  
  OBJECTIVE
  The objective of this study was to determine whether steroid use influenced the outcomes of liver transplantations.
  
  
  METHODS
  Three hundred forty-four adult patients underwent liver transplantation between May 2002 and December 2007. We reviewed the medical records of these patients, excluding those younger than 18 years old or those who died within the first month. The protocol withdrawal group (group 1) ceased steroid use within 5 months after transplantation, while the late withdrawal group (group 2) continued steroid use beyond this 5-month posttransplantation period.
  
  
  RESULTS
  All patients were classified according to the onset of steroid withdrawal (group 1: n = 243; group 2: n = 99). The incidences of biopsy-confirmed and treated acute rejection episodes (ARE) at 12 and 24 months posttransplantation were 7.8% and 12.3% in group 1, but 25.3% and 27.3% in group 2, respectively (P = .001). The incidence of hepatitis B virus (HBV) recurrence in group 2 was higher than that in group 1 (P = .007). The HBV-free survival rates at 1 and 2 years posttransplantation were 99.0% and 97.1% in group 1 and 96.1% and 92.1% in group 2, respectively. New-onset diabetes, avascular necrosis of the femoral head, corticosteroid-resistant ARE, hepatocellular carcinoma recurrence, as well as graft and patient survivals did not differ between the two groups.
  
  
  CONCLUSIONS
  Acute rejection episodes and HBV recurrence occurred less frequently when steroids were discontinued within 5 months after liver transplantation.
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: J M
authors.initials: JM
authors.lastname: Kim
authors.forename: J-W
authors.initials: JW
authors.lastname: Joh
authors.forename: S-J
authors.initials: SJ
authors.lastname: Kim
authors.forename: C H D
authors.initials: CH
authors.lastname: Kwon
authors.forename: S
authors.initials: S
authors.lastname: Song
authors.forename: M
authors.initials: M
authors.lastname: Shin
authors.forename: S H
authors.initials: SH
authors.lastname: Hong
authors.forename: S-K
authors.initials: SK
authors.lastname: Lee
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000503:physiopathology; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006509:Hepatitis B / Q000503:physiopathology; D006801:Humans; D008113:Liver Neoplasms / Q000503:physiopathology; D016031:Liver Transplantation; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D013375:Substance Withdrawal Syndrome; D015996:Survival Rate
chemical_list: D000305:Adrenal Cortex Hormones