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• W2050489673 abstract "48 Long term complications of steroid administration are well appreciated. This trial attempted complete discontinuation of steroids in stable liver recipients. Methods 122 liver transplant recipients were evaluated for steroid withdrawal. Inclusion criteria included: No prior OKT3 use, stable graft function > 3mos post-OLT, no rejection episodes within 2 mos, and no technical complications. In all patients complete steroid withdrawal was attempted. The prednisone dose was first lowered to 5mgs every other day and then discontinued after one month. Seventy-five patients completed the trial, 40 male and 35 female. Liver enzymes were obtained bimonthly. For confirmed doubling of the AST, patients underwent liver biopsy and appropriate treatment. Of the 75 patients, 10 were maintained on Neoral, and 65 on Prograf. Indications for transplantation included 25 Hep C, 18 ARLD, 7 Cryptogenic, 5 PBC, 5 PSC, 5 hepatomas, 4 Autoimmune, 4 Fulminant Failure and 2 others. Results Two patients were excluded for retransplantation not associated with rejection. One of these required retransplantation due to Rezulin toxicity and expired. Of the 75 patients that proceeded to complete steroid withdrawal, only 5 required the reinitiation of steroids for biopsy proven rejection. There were no grafts lost to rejection. Mean follow-up was 6 months. Biopsy proven rejections occurred at a mean of 3.2mos (1-7). Mean time to steroid withdrawal was 24 months (4-78). Blood pressure control improved in 17/27 (62.9%) hypertensive patients. Diabetes improved in 13/19 (68.4%) and 6(31.6%) no longer required insulin. Lethargy and joint pain were common new complaints in patients who had their steroids discontinued. Of the 122 patients in the study, 76 were Prograf based. Sixty-five (85.5%) were weaned off steroids without rejection. Of the 11 remaining, 6 patients could not be weaned to 5 mg on alternate days and 5 restarted steroids due to rejection occurring 1-7 months after cessation. Forty-four patients were Neoral based. Ten Neoral patients tolerated steroid withdrawal and there were no rejections in this group. The remaining 34 (77.4%) could not tolerate the steroid decrease to 5 mgs on alternate days. Steroid withdrawal was successfully completed more often in Prograf patients. This was statistically significant at p <.0001.TableConclusion Liver graft recipients may be weaned from steroids. Rejection in a preselected group of patients was 6.6%. Rejection required only the reinstitution of steroids. OKT3 use was unnecessary. Patients on Prograf are more likely to tolerate steroid withdrawal than are those receiving Neoral(p<0.0001)." @default.
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• W2050489673 date "1998-05-01" @default.
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• W2050489673 title "STEROID WITHDRAWAL IS SAFE AND FEASIBLE IN STABLE LIVER TRANSPLANT RECIPIENTS." @default.
• W2050489673 doi "https://doi.org/10.1097/00007890-199805131-00048" @default.
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