Prednisone withdrawal late after adult liver transplantation reduces diabetes, hypertension, and hypercholesterolemia without causing graft loss
✍ Scribed by M. D. Stegall; G. T. Everson; G. Schroter; F. Karrer; B. Bilir; T. Sternberg; R. Shrestha; M. Wachs; I. Kam
- Publisher
- John Wiley and Sons
- Year
- 1997
- Tongue
- English
- Weight
- 228 KB
- Volume
- 25
- Category
- Article
- ISSN
- 0270-9139
No coin nor oath required. For personal study only.
✦ Synopsis
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 years
We 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 Nineteen patients had prednisone withdrawn year.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 were
In 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 Steroids later were after transplantation to determine if the metabolic complicasuccessfully withdrawn in two of these patients.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.
PATIENTS AND METHODS
Four
of fourteen hypertensive patients were able to discontinue antihypertensive medicines. Mean serum cho-Patients included in the study were at least 2 years after orthotopic lesterol decreased from 222.6 { 43.3 to 188.3 { 33.3 mg/ liver transplantation (mean, 4.1 { 1.2 years; range, 2.0-5.9 years) who had stable hepatic allograft function (serum transaminases õ dL (P õ .001). The number of patients with serum choles-50 IU/mL). The mean age was 52.1 { 9.0 years (range, 35.1-69.1 terol levels ú 220 mg/dL decreased from 13 to 4. A control years). Neither prior rejection episodes nor underlying disease im-From the