title: Impact of steroid-avoidance immunosuppression on long-term outcome after liver transplantation for HCV cirrhosis: the need for well documented long-term follow-up.
abstract: OBJECTIVE
  study impact of steroid avoidance on HCV recurrence after transplantation.
  
  
  METHODS
  35 HCV pats, being part of prospective, randomized, double-blind, placebo-controlled study comparing Tacrolimus (TAC)-Placebo (PLAC) (n = 14) to TAC-short-term (2 mo) low-dose steroid (STER) (n = 21), had 5 years follow-up. Primary endpoint was 1 and 5 years survival; secondary (composite) endpoint comprised HCV related cirrhosis, re-transplantation (re-LT) and death.
  
  
  RESULTS
  1 and 5-years survival were 93% and 75% in TAC-PLAC group; 91% and 66% in TAC-STER group (p 0.38). Two (14.3%) TAC-PLAC pats died due to HCV cirrhosis at 54 and 72 mo; 7 (33%) TAC-STER pats died due to cholestatic hepatitis at 5.8 and 9 mo, to cirrhosis at 18, 22, 34, 73 and 79 mo (p 0.20). Composite endpoint at 5 years didn't show advantage in favor of TAC-PLAC patients (5/14 [35.7%] vs. 9/21 [42.8%] pts, p.0.69). Early biopsies seemed more favorable in TAC-PLAC pats; at 5 years results were identical for both groups. Only 1 (7.1%) TAC-PLAC and 2 (9.5%) TAC-STER pats needed rejection treatment.
  
  
  CONCLUSIONS
  immunosuppression using steroid avoidance or short-term use had similar outcomes. Well documented long-term follow-up, including biopsies, is necessary in order to make conclusions in relation to impact of steroid use on outcome of HCV liver recipients.
authors: Department of Abdominal and Transplantation Surgery, Th. Starzl Unit of Abdominal Transplantation, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
authors: E
authors: E
authors: Bonaccorsi-Riani
authors: C
authors: C
authors: Sempoux
authors: N
authors: N
authors: Piette
authors: O
authors: O
authors: Julliard
authors: B
authors: B
authors: Kabamba
authors: O
authors: O
authors: Ciccarelli
authors: F
authors: F
authors: Roggen
authors: C
authors: C
authors: De Reyck
authors: Z
authors: Z
authors: Hassoun
authors: J
authors: J
authors: Lerut
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage / Q000009:adverse effects; D001706:Biopsy; D004311:Double-Blind Method; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects / Q000276:immunology; D006526:Hepatitis C / Q000150:complications / Q000276:immunology / Q000503:physiopathology; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D008103:Liver Cirrhosis / Q000209:etiology / Q000601:surgery; D016031:Liver Transplantation / Q000276:immunology / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015166:Monitoring, Immunologic / Q000379:methods; D055502:Secondary Prevention; D016019:Survival Analysis; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects; D013995:Time; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D016559:Tacrolimus