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Corticosteroid withdrawal after liver transplantation
J D Punch1, V L Shieck, D A Campbell
1Department of Surgery, University of Michigan Medical School, Ann Arbor, USA.
Surgery
|October 1, 1995
Summary
Corticosteroid withdrawal is safe for liver transplant recipients with stable graft function, significantly reducing hypertension and hypercholesterolemia. This allows patients to discontinue steroid therapy without increasing rejection risk.
Area of Science:
- Transplantation Medicine
- Immunosuppression Therapy
- Graft Survival
Background:
- Long-term corticosteroid (CS) use in orthotopic liver transplant (OLT) recipients causes significant morbidity.
- Investigating CS withdrawal is crucial to understand its contribution to adverse outcomes and necessity for preventing rejection.
Purpose of the Study:
- To assess the feasibility and safety of corticosteroid withdrawal in OLT recipients.
- To determine if CS cessation impacts graft rejection rates.
- To quantify the effect of CS withdrawal on clinical sequelae.
Main Methods:
- A cohort of OLT recipients with stable graft function on CS, cyclosporine, and azathioprine underwent planned CS withdrawal over 12–22 weeks.
- Patients were monitored for clinical and laboratory parameters.
- Paired t-tests were used for continuous variable comparisons.
Main Results:
- 88% of 51 recipients remained steroid-free after a mean follow-up of 13.8 months.
- No significant changes in liver function tests, bilirubin, or glucose were observed.
- Significant reductions in blood pressure medication requirements (p=0.007), cholesterol levels (p=0.0001), and average weight loss of 9.5 pounds were noted.
Conclusions:
- Corticosteroid therapy can be safely withdrawn in OLT recipients with stable graft function one year post-transplant.
- CS withdrawal effectively reduces the incidence and severity of hypertension and hypercholesterolemia.
- This strategy improves long-term outcomes for liver transplant patients.