Prednisone withdrawal late after adult liver transplantation reduces diabetes, hypertension, and hypercholesterolemia without causing graft loss

Abstract

plantation are due to cardiovascular disease and another 40% We prospectively withdrew prednisone in 28 adult paare due to infection. 4 tients who had stable graft function more than 2 yearsWe previously have observed a high prevalence of cardioafter orthotopic liver transplantation (OLTx) and had vascular risk factors in patients late after liver transplantabeen on 5 mg/d prednisone for at least 6 months. Prednition. 4 One year after successful liver transplantation in our sone was decreased from 5 mg/d to 2.5 mg/d for 1 month patient population, the incidence of diabetes was 13% and then stopped completely. Cyclosporine monotherapy the incidence of hypertension was 69.1%. In addition, 31% of was maintained at a level of approximately 200 ng/mL our patients had serum cholesterol levels ú 240 ng/mL at 1 (TDX). Nineteen patients had prednisone withdrawn year. Tapering of prednisone from 10 mg/d to 5 mg/d dewithout complications. Four (14.2%) had modest elevacreased these metabolic complications in some patients and tions in liver function tests (two biopsy proven mild resignificantly decreased serum cholesterol levels. jections and two were not biopsied). These four wereIn this study, we further explore the role of prednisone in treated with methylprednisolone boluses and then withthe development of metabolic complications after liver transdrawal of steroids again. Prednisone was restarted in plantation. We prospectively withdrew prednisone in liver five patients because of generalized fatigue and body transplantation recipients who had survived at least 2 years aches (n Å 4) and colitis (n Å 1). Steroids later were after transplantation to determine if the metabolic complicasuccessfully withdrawn in two of these patients. After tions such as diabetes, hypertension, and hypercholesterolprednisone withdrawal, three of five insulin-dependent emia could be decreased. diabetic patients were able to discontinue insulin therapy and their glycosylated hemoglobin levels improved. ied. In this group during the study period, no diabetic also were excluded because they do not receive maintenance prednibecame normoglycemic, no patient decreased their anti-sone immunosuppression at our center. No children were included hypertensive medicine, and the mean serum cholesterol in this study. levels did not change significantly. We conclude that At the time of the study, 52 patients at our institution were at prednisone withdrawal using cyclosporine monother-least 2 years after OLTx and on 5 mg/d of prednisone. Twelve patients were excluded from this initial study because they had a hisapy late after liver transplantation does not lead to graft Two patients refused participation. Finally, 28 patients were included in the study. No patient was dropped from the study after enrollment. The 24 patients not included in the steroid withdrawal As more patients enjoy long-term survival after liver trans-study were maintained on 5 mg/d prednisone throughout the study period and continued to be followed with monthly laboratory values. planta...

Serum cholesterol changes in long-term survivors of liver transplantation: A comparison between cyclosporine and tacrolimus therapy

“…9 The fact that immunologic graft loss is rare after liver transplantation, combined with the severe side effects of long-term prednisone therapy, supports steroid withdrawal in liver transplant recipients. 8,10 In our series, as in other groups, steroid withdrawal was achieved earlier and in more patients receiving tacrolimus than cyclosporine therapy. 11,12 However, other studies showed no difference in steroid withdrawal between tacrolimus-and cyclosporine-treated patients.…”

“…8 The majority of studies of steroid withdrawal after liver transplantation have been conducted in pediatric transplant recipients. 9 The fact that immunologic graft loss is rare after liver transplantation, combined with the severe side effects of long-term prednisone therapy, supports steroid withdrawal in liver transplant recipients.…”

Long-term Medical Management of the Liver Transplant Recipient: What the Primary Care Physician Needs to Know

“…Options include reduction in corticosteroids, 17 substituting tacrolimus for cyclosporine, 18 reducing CNI doses by adding mycophenolate mofetil (MMF), 19 or converting to sirolimus-based immunosuppression. 20 These decisions should be made with the transplant hepatologist involved.…”

Prednisone withdrawal advocates: Beware of recurrent autoimmune hepatitis

“…6 from the University of California Los Angeles reported in 1995 that only 2 of 33 patients receiving cyclosporine therapy who underwent steroid withdrawal experienced biopsy-proven rejection. At the University of Colorado, Stegall et al 7 prospectively withdrew prednisone in 28 adult OLT patients. Two patients experienced biopsy-proven rejection and 2 others experienced elevation of liver tests but were not biopsied.…”