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Impact of immunosuppression without steroids on rejection and hepatitis C virus evolution after liver transplantation: results of a prospective randomized study.
- Source :
-
Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2008 Dec; Vol. 14 (12), pp. 1752-60. - Publication Year :
- 2008
-
Abstract
- 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 = 0.67). Patients in the St group had a slightly higher rate of bacterial infections (59% versus 38%; P = 0.05). Almost all patients had histological HCV-recurrence (St: 39/40 (97%) versus NoSt: 40/41 (97%); P = 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 = 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.
- Subjects :
- Adult
Antibodies, Monoclonal adverse effects
Basiliximab
Cyclosporine adverse effects
Evolution, Molecular
Female
Glucocorticoids therapeutic use
Graft Rejection pathology
Graft Rejection virology
Hepacivirus drug effects
Hepacivirus isolation & purification
Hepatitis C, Chronic complications
Humans
Liver Cirrhosis etiology
Liver Cirrhosis surgery
Liver Cirrhosis virology
Male
Methylprednisolone therapeutic use
Middle Aged
Prospective Studies
Recombinant Fusion Proteins adverse effects
Secondary Prevention
Antibodies, Monoclonal therapeutic use
Cyclosporine therapeutic use
Graft Rejection prevention & control
Hepatitis C, Chronic prevention & control
Immunosuppression Therapy methods
Immunosuppressive Agents therapeutic use
Liver Transplantation
Recombinant Fusion Proteins therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1527-6473
- Volume :
- 14
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
- Publication Type :
- Academic Journal
- Accession number :
- 19025919
- Full Text :
- https://doi.org/10.1002/lt.21629