A prospective, randomized trial of complete avoidance of steroids in liver transplantation with follow‐up of over 7 years. Issue 4 (28th September 2012)

• Record Type: Journal Article
• Authors: Pelletier, Shawn J.; Nadig, Satish N.; Lee, David D.; Ammori, John B.; Englesbe, Michael J.; Sung, Randall S.; Magee, John C.; Fontana, Robert J.; Punch, Jeffrey D.
• Is Part Of: HPB. Volume 15:Issue 4(2013:Apr.)
• Page Start: 286
• Page End: 293
• Publication Date: 2012-09-28
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/j.1477-2574.2012.00576.x
• Languages: English
• ISSNs: 1365-182X

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="hpb572-sec-0011" sec-type="section"> <title>Objectives</title> <p>Steroids are a mainstay of treatment in orthotopic liver transplantation (OLT) and are associated with significant morbidity. This trial was conducted to assess the efficacy of steroids avoidance.</p> </sec> <sec id="hpb572-sec-0012" sec-type="section"> <title>Methods</title> <p>Patients undergoing OLT between June 2002 and April 2005 were entered into a prospective, randomized trial of complete steroids avoidance and followed until November 2011. Recipients received either standard therapy (<italic>n</italic> = 50) or complete steroids avoidance (<italic>n</italic> = 50). Analyses were performed on an intention‐to‐treat basis. The mean follow‐up of all recipients was 2095 ± 117 days. Sixteen (32%) recipients randomized to the steroids avoidance group ultimately received steroids for clinical indications.</p> </sec> <sec id="hpb572-sec-0013" sec-type="section"> <title>Results</title> <p>Incidences of diabetes and hypertension prior to or after OLT were similar in both groups, as was the incidence of rejection. Patient and graft survival rates at 1, 3 and 5 years were lower in the steroids avoidance group than in the standard therapy group (patient survival: 1‐year, 80% versus 86%; 3‐year, 68% versus 76%; 5‐year, 60% versus 72%; graft survival: 1‐year, 76% versus 76%; 3‐year, 64% versus 74%; 5‐year, 56% versus 72%), but the differences were not statistically different.</p> </sec> <sec id="hpb572-sec-0014" sec-type="section"> <title>Conclusions</title> <p>Complete steroids avoidance provides liver transplant recipients with minimal benefit and appears to result in a concerning trend towards decreased graft and recipient survival. The present data support the use of at least a short course of steroids after liver transplantation.</p> </sec> </abstract>