Higher incidence of rejection following early steroid withdrawal

December 01, 2004

A new study on early steroid withdrawal following liver transplantation found that there was a higher incidence of rejection and a lower incidence of glucose intolerance necessitating treatment for diabetes. It was the first double-blind placebo-controlled study to examine the effects of early steroid elimination.

The results of this study appear in the December 2004 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS). The journal is published on behalf of the societies by John Wiley & Sons, Inc. and is available online via Wiley InterScience at http://www.interscience.wiley.com/journal/livertransplantation.

The normal course of treatment after liver transplantation includes calcineurin inhibitors (a class of immunosuppressants) and steroids to minimize rejection and improve survival rates, but the long-term complications of these drugs can be fatal. Steroid use in particular can lead to diabetes, high cholesterol and hypertension, which increase the risk of heart disease, and can lead to death. Several previous studies have reported that early withdrawal from steroids reduced the incidence of these side effects, but that rejection increased, although it could be controlled with steroid pulse therapy (in which high doses of steroids are administered intravenously for a short period of time). The current multicenter study was the first prospective double-blind, placebo-controlled trial to compare early steroid withdrawal with continued use.

Led by Georges-Philippe Pageaux, of the Centre Hospitalier University St.-Eloi in Montpellier, France, the study examined 174 patients in 15 French liver transplantation centers over a 14-month period from December 1999 to August 2001. The patients were randomly divided into two groups seven days following transplant: 90 of them continued to receive steroids for six months, while 84 received a placebo starting at day 14 (following 7 days of tapering from steroids). At the end of six months, 22 patients in the steroid group (24.4 percent) and 32 patients in the placebo group (38.1 percent) experienced acute rejection. Although there was no statistical difference in the two groups for high cholesterol and hypertension, 22.2 percent of patients in the steroid group developed diabetes compared with 14.3 percent of placebo patients. At the end of 12 months, the incidence of acute rejection was 25.6 percent in the steroid group versus 39.3 percent in the placebo group, but there no longer a difference in diabetes between the two groups.

"Although the incidence of acute rejection in the placebo group was increased, it was easily controlled in most of the cases and did not affect long-term graft histology or survival," the authors note, adding that the increase may ultimately be acceptable if steroids could be eliminated. However, the main goal of steroid elimination is to reduce metabolic complications and this study showed no difference in cholesterol or hypertension, with a trend toward a decreased incidence of diabetes in the placebo group.

The authors conclude: "Indeed, while there are many arguments in favor of corticosteroid withdrawal beyond 3 months posttransplantation, in terms of safety and efficacy, our study demonstrates that earlier withdrawal at day 14 is not completely safe in terms of rejection, but seems efficient in terms of improvement of glucose tolerability," which could decrease long-term mortality due to cardiovascular disease.
-end-
Article: "Steroid Withdrawal at Day 14 After Liver Transplantation: A Double-Blind, Placebo-Controlled Study," Georges-Philippe Pageaux, Yvon Calmus, Olivier Boillot, Christian Ducerf, Claire Vanlemmens, Karim Boudjema, Didier Samuel, and the French CHI-F001 Study Group, Liver Transplantation; December 2004; 10:12; pp. 1454-1460 (DOI: 10.1002/lt.20291).

Wiley

Related Diabetes Articles from Brightsurf:

New diabetes medication reduced heart event risk in those with diabetes and kidney disease
Sotagliflozin - a type of medication known as an SGLT2 inhibitor primarily prescribed for Type 2 diabetes - reduces the risk of adverse cardiovascular events for patients with diabetes and kidney disease.

Diabetes drug boosts survival in patients with type 2 diabetes and COVID-19 pneumonia
Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy.

Making sense of diabetes
Throughout her 38-year nursing career, Laurel Despins has progressed from a bedside nurse to a clinical nurse specialist and has worked in medical, surgical and cardiac intensive care units.

Helping teens with type 1 diabetes improve diabetes control with MyDiaText
Adolescence is a difficult period of development, made more complex for those with Type 1 diabetes mellitus (T1DM).

Diabetes-in-a-dish model uncovers new insights into the cause of type 2 diabetes
Researchers have developed a novel 'disease-in-a-dish' model to study the basic molecular factors that lead to the development of type 2 diabetes, uncovering the potential existence of major signaling defects both inside and outside of the classical insulin signaling cascade, and providing new perspectives on the mechanisms behind insulin resistance in type 2 diabetes and possibly opportunities for the development of novel therapeutics for the disease.

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.

Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.

Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).

Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.

People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.

Read More: Diabetes News and Diabetes Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.