Corticosteroid-free strategies in liver transplantation.

Corticosteroid avoidance is feasible and may be desirable in liver transplantation. Approximately 50% of liver transplant recipients who use calcineurin inhibitors and azathioprine do not need corticosteroids. The availability of newer agents, such as mycophenolate mofetil and antibody therapy, has increased the percentage of patients who do not need to use corticosteroids to about 75%. The feasibility of corticosteroid-free immunosuppression has been established by controlled trials demonstrating non-inferiority with respect to patterns of rejection as well as patient and graft survival. However, the evidence available to date does not unequivocally establish the benefits of corticosteroid-free immunosuppression, although some advantage has been established relating to post-transplant diabetes mellitus, cytomegalovirus infection and growth patterns in children. The effect of corticosteroid-free immunosuppression in hepatitis C liver transplant recipients is yet to be resolved.