Impact of immunosuppression without steroids on rejection and hepatitis C virus evolution after liver transplantation: Results of a prospective randomized study

✍ Scribed by Laura Lladó; Joan Fabregat; Jose Castellote; Emilio Ramos; Xavier Xiol; Jaume Torras; Teresa Serrano; Carme Baliellas; Joan Figueras; Agustin Garcia-Gil; Antoni Rafecas

• Publisher: John Wiley and Sons
• Year: 2008
• Tongue: English
• Weight: 296 KB
• Volume: 14
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21629

✦ Synopsis

The purpose of this study was to evaluate the influence of a steroid-free immunosuppression on hepatitis C virus (HCV) recurrence. A total of 198 liver transplantation (LT) patients were randomized to receive immunosuppression with basiliximab and cyclosporine, either with prednisone (steroid [St] group) or without prednisone (no steroids [NoSt] group). The group of 89 HCV-infected patients was followed up with protocol biopsies for 2 years after LT. This group of HCV patients are the patients evaluated in the present study. The rejection rate was 19% (St: 21% versus NoSt: 17%; P ϭ 0.67). Patients in the St group had a slightly higher rate of bacterial infections (59% versus 38%; P ϭ 0.05). Almost all patients had histological HCVrecurrence (St: 39/40 (97%) versus NoSt: 40/41 (97%); P ϭ 1). The percentage of accumulated biopsies with grade 4 portal inflammation at 6 months, 1 year, and 2 years were, 23%, 49%, and 49% in the NoSt group, compared to 33%, 55%, and 69% in the St group, respectively (P ϭ 0.04 at 2 years). The percentage of accumulated biopsies with grade 3 or 4 fibrosis at 6 months, 1 year, and 2 years were 0%, 8%, and 22% in the NoSt group, compared to 8%, 19%, and 31% in the St group, respectively. Immunosuppression without steroids in HCV patients is safe, reduces bacterial infections and metabolic complications, and improves histological short-term evolution of HCV recurrence.