Beneficial effect of intra-operative methylprednisolone on immediate post liver transplant intensive care course

Concern about the effect of corticosteroids on outcomes following liver transplantation (LT), especially in recipients with hepatitis C infection (HCV) has lead many centres to abandon the use of perioperative steroids. Avoidance of corticosteroids in immunosuppressive regimens may have beneficial effects in terms of reducing the incidence of infection, new onset diabetes mellitus and HCV recurrence however perioperative use may have beneficial effects such as attenuation of ischaemia-reperfusion injury (IR) and treatment of underlying adrenal insufficiency (AI). Due to a high prevalence of adrenal insufficiency in patients on our waiting list for LT, we reintroduced the use of intraoperative methyl-prednisolone and hypothesised that this would improve early post operative outcome.

90 consecutive patients were studied, 45 before (group 1) and 45 (group 2) after the protocolised reintroduction of methylprednisolone (1g IV) intraoperatively prior to reperfusion. Peri- and post-transplant requirements for colloid, crystalloid, blood products, vasopressors, renal replacement therapy and ventilation were compared between groups. No other changes to the transplant protocol occurred during the study period.

Patients who received intraoperative methlyprednisolone had significantly shorter post operative ITU stay, vasopressor and colloid requirement post LT, and were dependent on mechanical ventilation for less time.

These data suggest that the use of intraoperative methylprednisolone can modify the immediate post transplant course of LT, either by attenuating reperfusion induced inflammation, or by addressing hitherto unrecognized adrenal insufficiency.