OBJECTIVES: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. METHODS: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 (n = 50) or complete steroids avoidance (n = 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. RESULTS: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. CONCLUSIONS: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.
RCT Entities:
OBJECTIVES: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. METHODS: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 (n = 50) or complete steroids avoidance (n = 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. RESULTS: 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. CONCLUSIONS: 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.
Authors: J I Tchervenkov; A J Tector; M Cantarovich; S A Tahta; A Asfar; J Naimi; N Elias; J Barkun Journal: Transplant Proc Date: 1996-08 Impact factor: 1.066
Authors: G Tisone; M Angelico; G Palmieri; F Pisani; A Anselmo; L Baiocchi; S Negrini; G Orlando; G Vennarecci; C U Casciani Journal: Transplantation Date: 1999-05-27 Impact factor: 4.939
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: Olivier Boillot; David A Mayer; Karim Boudjema; Mauro Salizzoni; Bruno Gridelli; Franco Filipponi; Pavel Trunecka; Marek Krawczyk; Pierre-Alain Clavien; Christian Ducerf; Carlos Margarit; Raimund Margreiter; José Mir Pallardo; Krister Hoeckerstedt; George-Phillipe Pageaux Journal: Liver Transpl Date: 2005-01 Impact factor: 5.799
Authors: J M Langrehr; U P Neumann; M Lang; A R Müller; S Jonas; U Settmacher; T Steinmüller; P Neuhaus Journal: Transplant Proc Date: 2002-08 Impact factor: 1.066
Authors: Khurram Bari; Shimul A Shah; Tiffany E Kaiser; Robert M Cohen; Nadeem Anwar; David Kleesattel; Kenneth E Sherman Journal: Liver Transpl Date: 2020-08-19 Impact factor: 5.799
Authors: Manuel Rodríguez-Perálvarez; Marta Guerrero-Misas; Douglas Thorburn; Brian R Davidson; Emmanuel Tsochatzis; Kurinchi Selvan Gurusamy Journal: Cochrane Database Syst Rev Date: 2017-03-31
Authors: Lawrence Mj Best; Jeffrey Leung; Suzanne C Freeman; Alex J Sutton; Nicola J Cooper; Elisabeth Jane Milne; Maxine Cowlin; Anna Payne; Dana Walshaw; Douglas Thorburn; Chavdar S Pavlov; Brian R Davidson; Emmanuel Tsochatzis; Norman R Williams; Kurinchi Selvan Gurusamy Journal: Cochrane Database Syst Rev Date: 2020-01-16