Preliminary Short-Term Experience of Early Steroid Withdrawal after Liver Transplantation

초록

Purpose: Long-term steroid therapy after liver transplantation (LT) can cause diabetes mellitus, hypertension, hyperlipidemia, osteopenia, susceptibility to infection. To avoid many adverse effects of steroid, modified steroid protocols are studied. Methods: Among 46 transplants of 44 adult patients who received LT from December 2007 to September 2011, 39 recipients were reviewed. We divided recipients into three groups according to steroid therapy period: (1) ≥ 6 months (group A) (2) 1 - <6 months (group B) (3) 2 weeks (group C). Acute rejection (AR) that was proved by liver biopsy and serious complications were investigated. Intravenous methylprednisolone 500mg was given for operative day and postoperative day (POD) 1 and then tapered. On POD 6, we changed methylprednisolone to prednisolone and discontinued on POD 15. Results: In group A (n=12), the mean period of steroid therapy was 8.8 months (range: 6.3-13.7). In this group, 4 AR, 4 posttransplant diabetes mellitus (PTDM), 1 invasive pulmonary aspergillosis (IPA), 1 avascular necrosis (AVN) of hip joint, 1 pneumonia, 1 intraabdominal abscess and 1 varicella zoster developed. IPA and AVN developed in patients treated with intensive immunosuppression due to AR. The patient who suffered from intraabdominal abscess was died of systemic infection at 6 months after operation. In group B (n=12), the mean period of steroid therapy was 3.2 months (range: 1.1-5.3). In this group, 1 AR, 1 PTDM, 2 pneumonia and 1 varicella zoster developed. Among them, one patient who was diagnosed pneumonia was died at 5 months after LT. In group C (n=15), 1 AR, 1 PTDM, 1 reactivation of pulmonary tuberculosis, 1 intraabdominal abscess and 1 varicella zoster developed. Among them, one patient who was diagnosed intraabdominal abscess was died at 5 months due to arterial bleeding. The mean follow-up period between groups was 34 (A), 23.7 (B), 9.2 (C) months, respectively. Conclusion: Even though we need further follow-up, discontinuation of steroid within 2 weeks can be comparable to the long-term therapy regarding AR with the benefit of reduced complication rate.