If steroids are withdrawn early following liver transplantation, a higher incidence of rejection and a lower incidence of intolerance to glucose may be seen to necessitate treatment for diabetes.
This finding came to limelight after a first double-blind placebo-controlled study was conducted with an aim to examine the effects of early steroid withdrawal. This study was published in an 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).
From News-Medical.Net:
“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.
It is believed by the medical fraternity that this study on early steroid withdrawal will help medical practitioners to handle this concerning issue with a greater sense of caution and diligence.
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