title: Reduction in corticosteroids is associated with better health-related quality of life after liver transplantation.
abstract: BACKGROUND
  Corticosteroid use during post-transplant immunosuppression contributes to documented long-term complications in liver transplant recipients. However, the effects of steroids on post-transplant physical and mental health-related quality of life (HRQOL) have not been established. We aimed to test the association between steroid-based immunosuppression and post-transplant HRQOL in liver transplant recipients.
  
  
  METHODS
  We performed a retrospective analysis of prospective, longitudinal HRQOL measured using the Short Form 36 Health Survey physical and mental component summary scores, Beck Anxiety Inventory, and Center for Epidemiologic Studies Depression Scale. Steroid use (none, low [<10 mg/d], high [≥10 mg/d]) and temporally associated acute rejection (within previous 6 weeks, previous 7 to 12 weeks, and never or >12 weeks before HRQOL measurement) were determined at every post-transplant HRQOL data point. Linear mixed-effects models tested the effects of contemporaneous steroid use and dosing on post-transplant HRQOL.
  
  
  RESULTS
  The sample included 186 adult liver transplant recipients (mean age 54 ± 8 years, 70% male) with pre- and at least 1 post-transplant HRQOL data point. Individual follow-up post-transplant averaged 21 ± 18 months (range 1 to 74 months). After controlling for pre-transplant HRQOL, time post-transplant, pre-transplant diagnosis group, and temporally associated episodes of rejection, post-transplant high-dose steroid use (≥10 mg/d) was associated with lower physical component summary (p < 0.001) and mental component summary (p = 0.049) scores and increased Beck Anxiety Inventory (p = 0.015) scores. Low-dose steroid use (<10 mg/d) was not associated with post-transplant HRQOL in any model (all p ≥ 0.28).
  
  
  CONCLUSIONS
  High-dose steroid use for post-transplant immunosuppression in liver transplant recipients was associated with reduced physical and mental HRQOL, and increased symptoms of anxiety. There was an association between better HRQOL and steroid reduction to <10 mg/d in liver transplant recipients during a broad follow-up period.
authors.affiliation: Department of Surgery and Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN, USA. zaydfudim.victor@mayo.edu
authors.forename: Victor
authors.initials: V
authors.lastname: Zaydfudim
authors.forename: Irene D
authors.initials: ID
authors.lastname: Feurer
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Landman
authors.forename: Derek E
authors.initials: DE
authors.lastname: Moore
authors.forename: J Kelly
authors.initials: JK
authors.lastname: Wright
authors.forename: C Wright
authors.initials: CW
authors.lastname: Pinson
mesh_terms: D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006084:Graft Rejection / Q000517:prevention & control*; D006305:Health Status Indicators; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016031:Liver Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011184:Postoperative Period; D020551:Pulse Therapy, Drug; D011788:Quality of Life
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents