title: Steroid elimination within 24 hours after orthotopic liver transplantation: effectiveness and tolerability.
abstract: BACKGROUND
  Steroids have been the mainstay of immunosuppressive regimen in liver transplantation. However, the use of steroids is associated with various post-transplant complications. This study evaluated the efficacy and safety of reduced immunosuppressive regimen with steroids (steroid elimination within 24 hours post-transplant) in a cohort of Chinese liver transplant recipients.
  
  
  METHODS
  Seventy-six patients in line with the selection criteria were enrolled in this prospective study. All patients received anti-IL-2 receptor antibody induction and tacrolimus-based maintenance therapy. The recipients were divided into two groups according to the duration of steroid use: 40 transplant in a 3-month withdrawal group and the remaining 36 in a 24-hour elimination group. Recipient survival, post-operative infections, biopsy-proven acute rejection and steroid-resistant acute rejection, non-healing wound, recurrence of hepatitis B virus (HBV) and hepatocellular carcinoma (HCC), de novo diabetes, hyperlipidemia and hypertension were assessed in the two groups.
  
  
  RESULTS
  There was no significant difference in patient survival, incidence of acute rejection episodes and hyperlipidemia, and recurrence of HBV and HCC between the two groups. However, the incidence rates of post-transplant infection, non-healing wound, de novo diabetes and hypertension were significantly lower in the 24-hour elimination group than in the 3-month withdrawal group (all P values <0.05).
  
  
  CONCLUSIONS
  Under anti-IL-2 receptor antibody induction and tacrolimus-based maintainance, steroid elimination within 24 hours post-transplant is associated with reduced steroid-related complications without increasing the risk of rejection.
authors.affiliation: Organ Transplantation Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China.
authors.forename: Lin-Wei
authors.initials: LW
authors.lastname: Wu
authors.forename: Zhi-Yong
authors.initials: ZY
authors.lastname: Guo
authors.forename: Qiang
authors.initials: Q
authors.lastname: Tai
authors.forename: Wei-Qiang
authors.initials: WQ
authors.lastname: Ju
authors.forename: Dong-Ping
authors.initials: DP
authors.lastname: Wang
authors.forename: An-Bin
authors.initials: AB
authors.lastname: Hu
authors.forename: Xiao-Feng
authors.initials: XF
authors.lastname: Zhu
authors.forename: Xiao-Shun
authors.initials: XS
authors.lastname: He
mesh_terms: D000888:Antibodies, Anti-Idiotypic / Q000009:adverse effects / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D002681:China; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology* / Q000517:prevention & control*; D006509:Hepatitis B / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality; D011446:Prospective Studies; D015375:Receptors, Interleukin-2 / Q000276:immunology; D012008:Recurrence; D013256:Steroids / Q000009:adverse effects* / Q000627:therapeutic use*; D015996:Survival Rate; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D000888:Antibodies, Anti-Idiotypic; D007166:Immunosuppressive Agents; D015375:Receptors, Interleukin-2; D013256:Steroids; D016559:Tacrolimus