Journal Club: Early steroid-free immunosuppression with FK506 after liver transplantation

(Transplantation 2010;90:1562-1566)

Following liver transplantation, it is common to use two or three immunosuppressive medications, including a steroid.  Steroids have many side effects including components of the metabolic syndrome, osteoporosis, and in the setting of HCV infection there is always the concern of causing more virulent behavior.

This prospective, double-blind randomized trial evaluated the effects of steroid discontinuation after two weeks vs six months, with indefinite use of tacrolimus (FK506).  There were more steroid side-effects in the steroid group at six months but not at five years.  The authors reported no change in patient or graft survival at 5 years.  Acute cellular rejection rates were comparable.

We had several problems with this study.  The rate of recirrhosis at five years in the HCV group was reported, but there were deaths along the way that were unreported- were some of those deaths related to HCV recirrhosis?  Second, some of their data was reported as not-significant, but the hard values were not provided.  At this center, a triple regimen is used, and our steroid dosing is different than that used in this manuscript.  For the full manuscript, please refer to the unusually long link provided below:

http://ovidsp.tx.ovid.com/sp-3.3.0b/ovidweb.cgi?WebLinkFrameset=1&S=EAOCFPHCPGDDBMEENCCLFFFBLANHAA00&returnUrl=ovidweb.cgi%3f%26Full%2bText%3dL%257cS.sh.15.16%257c0%257c00007890-201012270-00051%26S%3dEAOCFPHCPGDDBMEENCCLFFFBLANHAA00&directlink=http%3a%2f%2fgraphics.tx.ovid.com%2fovftpdfs%2fFPDDNCFBFFEEPG00%2ffs046%2fovft%2flive%2fgv023%2f00007890%2f00007890-201012270-00051.pdf&filename=Early+Steroid-Free+Immunosuppression+With+FK506+After+Liver+Transplantation%3a+Long-Term+Results+of+a+Prospectively+Randomized+Double-Blinded+Trial.&pdf_key=FPDDNCFBFFEEPG00&pdf_index=/fs046/ovft/live/gv023/00007890/00007890-201012270-00051

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