Corticosteroid-free immunosuppression in liver transplantation: An evidence-based review

Thirty-six randomized controlled trials and two metaanalyses were reviewed. With respect to adult patients undergoing first orthotopic liver transplantation(OLT), steroid replacement resulted in fewer cases of overall acute rejection in the corticosteroid free-immunosuppression arm. Initial steroid...

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2014-08, Vol.20 (31), p.10703-10714
Main Authors: Sgourakis, George, Dedemadi, Georgia
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - adverse effects
Adrenal Cortex Hormones - therapeutic use
based
Drug Therapy, Combination
Evidence
Evidence-Based Medicine
Graft Rejection - immunology
Graft Rejection - prevention & control
Graft Survival - drug effects
Hepatitis
Humans
Immunosuppressive Agents - adverse effects
Immunosuppressive Agents - therapeutic use
Liver Transplantation - adverse effects
Meta-analysis
rec
Risk Factors
Topic Highlight
Treatment Outcome
virus
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Summary:Thirty-six randomized controlled trials and two metaanalyses were reviewed. With respect to adult patients undergoing first orthotopic liver transplantation(OLT), steroid replacement resulted in fewer cases of overall acute rejection in the corticosteroid free-immunosuppression arm. Initial steroid administration for two weeks and early tacrolimus monotherapy is a feasible immunosuppression regimen without steroid replacement, although further investigations are needed in view of chronic rejections. No significant differences were noted between the treatment groups in terms of patient and graft survival independently of steroid replacement. Renal insufficiency, de novo hypertension, neurological disorders and infectious complications did not differ significantly among steroid and steroidfree groups. Diabetes mellitus, cholesterol levels and cytomegalovirus infection are more frequent in patients within the steroid group. With respect to diabetes mellitus and hypercholesterolemia, the difference was independent of steroid replacement. In relation to transplanted hepatitis C virus patients, mycophenolate mofetil does not appear to have a significant antiviral effect despite early reports. Male gender of donors and recipients, living donors, cold ischemia times, acute rejection, and early histological recurrence were related to the development of advanced hepatitis. There is sufficient scientific clinical evidence advocating avoidance of the ab initio use of steroids in OLT.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v20.i31.10703