Zhi-Shui Chen1, Fan He, Fan-Jun Zeng, Ji-Pin Jiang, Dun-Feng Du, Bin Liu. 1. Institution of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China. zschen@tjh.tjmu.edu.cn
Abstract
AIM: To evaluate the impact of early steroid withdrawal on the incidence of rejection, tumor recurrence and complications after liver transplantation for advanced-stage hepatocellular carcinoma. METHODS: Fifty-four patients underwent liver transplantation for advanced-stage hepatocellular carcinoma from April 2003 to June 2005. These cases were divided into a steroid-withdrawal group (group A, n = 28) and a steroid-maintenance group (group B, n = 26). In group A, steroid was withdrawn 3 mo after transplantation. In group B, steroid was continuously used postoperatively. The incidence of rejection, 6-mo and 1-year recurrence rate of carcinoma, 1-year survival rate, mean serum tacrolimus trough level, and liver and kidney function were compared between the two groups. RESULTS: In the two groups, no statistical difference was observed in the incidence of rejection (14.3 vs 11.5%, P > 0.05), mean serum tacrolimus trough levels (6.9 +/- 1.4 vs 7.1 +/- 1.1 microg/L, P > 0.05), liver and kidney function after 6 mo [alanine aminotransferase (ALT): 533 +/- 183 vs 617 +/- 217 nka/L, P > 0.05; creatinine: 66 +/- 18 vs 71 +/- 19 micromol/L, P > 0.05], 6-mo recurrence rate of carcinoma (25.0 vs 42.3%, P > 0.05), and 1-year survival rate (64.2 vs 46.1%, P > 0.05). The 1-year tumor recurrence rate (39.2 vs 69.2%, P < 0.05), serum cholesterol level (3.9 +/- 1.8 vs 5.9 +/- 2.6 mmol/L, P < 0.01) and fasting blood sugar (5.1 +/- 2.1 vs 8.9 +/- 3.6 mmol/L, P < 0.01) were significantly different. These were lower in the steroid-withdrawal group than in the steroid-maintenance group. CONCLUSION: Early steroid withdrawal was safe after liver transplantation in patients with advanced-stage hepatocellular carcinoma. When steroids were withdrawn 3 mo post-operation, the incidence of rejection did not increase, and there was no demand to maintain tacrolimus at a high level. In contrast, the tumor recurrence rate and the potential of adverse effects decreased significantly. This may have led to an increase in long-term survival rate.
AIM: To evaluate the impact of early steroid withdrawal on the incidence of rejection, tumor recurrence and complications after liver transplantation for advanced-stage hepatocellular carcinoma. METHODS: Fifty-four patients underwent liver transplantation for advanced-stage hepatocellular carcinoma from April 2003 to June 2005. These cases were divided into a steroid-withdrawal group (group A, n = 28) and a steroid-maintenance group (group B, n = 26). In group A, steroid was withdrawn 3 mo after transplantation. In group B, steroid was continuously used postoperatively. The incidence of rejection, 6-mo and 1-year recurrence rate of carcinoma, 1-year survival rate, mean serum tacrolimus trough level, and liver and kidney function were compared between the two groups. RESULTS: In the two groups, no statistical difference was observed in the incidence of rejection (14.3 vs 11.5%, P > 0.05), mean serum tacrolimus trough levels (6.9 +/- 1.4 vs 7.1 +/- 1.1 microg/L, P > 0.05), liver and kidney function after 6 mo [alanine aminotransferase (ALT): 533 +/- 183 vs 617 +/- 217 nka/L, P > 0.05; creatinine: 66 +/- 18 vs 71 +/- 19 micromol/L, P > 0.05], 6-mo recurrence rate of carcinoma (25.0 vs 42.3%, P > 0.05), and 1-year survival rate (64.2 vs 46.1%, P > 0.05). The 1-year tumor recurrence rate (39.2 vs 69.2%, P < 0.05), serum cholesterol level (3.9 +/- 1.8 vs 5.9 +/- 2.6 mmol/L, P < 0.01) and fasting blood sugar (5.1 +/- 2.1 vs 8.9 +/- 3.6 mmol/L, P < 0.01) were significantly different. These were lower in the steroid-withdrawal group than in the steroid-maintenance group. CONCLUSION: Early steroid withdrawal was safe after liver transplantation in patients with advanced-stage hepatocellular carcinoma. When steroids were withdrawn 3 mo post-operation, the incidence of rejection did not increase, and there was no demand to maintain tacrolimus at a high level. In contrast, the tumor recurrence rate and the potential of adverse effects decreased significantly. This may have led to an increase in long-term survival rate.
Authors: J P Lerut; O Ciccarelli; E Mauel; R Gheerardhyn; S Talpe; C Sempoux; P F Laterre; F M Roggen; V Van Leeuw; J B Otte; P Gianello Journal: Transpl Int Date: 2001-12 Impact factor: 3.782
Authors: M D Stegall; G T Everson; G Schroter; F Karrer; B Bilir; T Sternberg; R Shrestha; M Wachs; I Kam Journal: Hepatology Date: 1997-01 Impact factor: 17.425
Authors: Z S Chen; F J Zeng; C S Ming; Z B Lin; W J Zhang; L Wei; X H Zhu; J P Jiang; Z K Chen Journal: Transplant Proc Date: 2004-10 Impact factor: 1.066
Authors: M D Stegall; M E Wachs; G Everson; T Steinberg; B Bilir; R Shrestha; F Karrer; I Kam Journal: Transplantation Date: 1997-12-27 Impact factor: 4.939
Authors: F Innocenti; J Hepp; R Humeres; E Sanhueza; R Zapata; H Rios; L Suárez; R Sandoval; M Rius; M Zamboni Journal: Transplant Proc Date: 2004 Jul-Aug Impact factor: 1.066
Authors: R T Padbury; B K Gunson; B Dousset; S G Hubscher; J A Buckels; J M Neuberger; E Elias; P McMaster Journal: Transplantation Date: 1993-04 Impact factor: 4.939
Authors: S V McDiarmid; D A Farmer; L I Goldstein; P Martin; J Vargas; J R Tipton; F Simmons; R W Busuttil Journal: Transplantation Date: 1995-12-27 Impact factor: 4.939
Authors: Jinyang Gu; Xingyu Wu; Lei Lu; Shu Zhang; Jianling Bai; Jun Wang; Jun Li; Yitao Ding Journal: Hepatol Int Date: 2014-03-20 Impact factor: 6.047
Authors: Wojciech Andrzej Straś; Dariusz Wasiak; Beata Łągiewska; Olga Tronina; Marta Hreńczuk; Joanna Gotlib; Wojciech Lisik; Piotr Małkowski Journal: Ann Transplant Date: 2022-01-26 Impact factor: 1.530