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Corticosteroids usage in pediatric liver transplantation: To be or not to be!

Siham Al-Sinani1, Anil Dhawan

  • 1Pediatric Liver Centre, King's College Hospital, London, UK.

Pediatric Transplantation
|November 29, 2008
PubMed

Insights

Early steroid withdrawal (SW) or elimination in pediatric liver transplant (LT) recipients is safe for patients and graft survival. Steroids negatively impact growth, and steroid-free regimens are beneficial.

Area of Science:

  • Pediatric Gastroenterology and Hepatology
  • Transplant Immunology
  • Pharmacology

Background:

  • Early steroid withdrawal (SW) and steroid-free immunosuppression protocols in pediatric liver transplantation (LT) are being explored.
  • Potential risks include acute graft rejection (AGR), chronic graft rejection (CGR), and de novo autoimmune hepatitis (d-AIH).
  • Benefits primarily involve improved post-LT growth outcomes.

Purpose of the Study:

  • To evaluate the risks and benefits of corticosteroid (CS) therapy in pediatric LT recipients.
  • To focus on CGR and d-AIH as key risks and growth effects as benefits.
  • To analyze clinical trials examining low-dose CS, SW, or steroid-free regimens.

Main Methods:

  • Systematic review and comparison of numerous clinical trials involving pediatric LT patients.
  • Analysis of data on graft survival, patient outcomes, growth parameters, and incidence of d-AIH.
  • Focus on short-term outcomes and the impact of different CS regimens.

Main Results:

  • Early SW or elimination from immunosuppression protocols did not negatively affect short-term patient or graft survival.
  • High-dose and prolonged CS therapy negatively impacts growth in LT recipients.
  • d-AIH development is not associated with CS therapy; chronic low-dose steroids do not prevent d-AIH.

Conclusions:

  • Early SW or steroid-free protocols are safe and beneficial for growth in pediatric LT.
  • Minimizing CS use is crucial for optimizing growth outcomes post-transplant.
  • Current evidence does not support a preventative role for low-dose steroids against d-AIH.

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