Steroid withdrawal is safe and beneficial in stable cyclosporine-treated liver transplant patients

Background: In the immunosuppression of orthotopic liver transplant recipients, steroids are used despite their unspecific action and long-term side effects. Few studies have been carried out on steroid withdrawal and many aspects remain to be elucidated. Methods: A prospective study was performed to analyse the effect of steroid withdrawal on 86 patients with stable graft function, more than 1 year after orthotopic liver transplant. Thirty patients had chronic hepatitis in the graft. Seventy-two continued with cyclosporine (CsA) and 14 with CsA-azathioprine (AZA) therapy. The follow-up was 23.2±8.1 months (range (12–52 months). A paired t-test was used for statistical analysis. Results: No acute or chronic rejection occurred, and steroids were not reinstituted. There were no changes in serum transaminase levels, but bilirubin levels decreased (p<0.01). At the end of the follow-up, we found improvements in blood pressure in hypertensive patients (systolic 156.1±8.4 mmHg vs. 139.4±8.7 mmHg, p<0.001); body weight (72±13.5 kg vs. 70.8±13 kg, p<0.05); serum cholesterol (211.3±42 mg/dl vs. 191.6±43.5 mg/dl, p<0.001) and bone mineral density in lumbar spine (0.823±0.13 g/cm2 vs. 0.893±0.135 g/cm2, p<0.001). Four of ten diabetic patients were no longer insulin-dependent and insulin requirements decreased in the remaining six. No significant biochemical changes were found in patients with hepatitis in the graft, and we found an improvement in inflammatory activity in the nine biopsed patients. Conclusions: Steroid withdrawal with CsA monotherapy is feasible, safe and beneficial in patients who have stable liver graft function 1 year after orthotopic liver transplant. We consider that AZA therapy is not necessary unless drastic reduction of CsA levels is required because of renal dysfunction.