LONG-TERM IMMUNOSUPPRESSION AFTER LIVER-TRANSPLANTATION - ARE STEROIDS NECESSARY

Steroid therapy was withdrawn in 85 % of 152 orthotopic liver transplant recipients with grafts surviving for more than 3 months, and 87 % of these remained steroid-free. Steroid therapy was restarted in 8 % for reasons other than rejection. The most common was conversion of immunosuppression because of cyclosporine nephrotoxicity. The incidence of rejection after steroid withdrawal was low: 3.8 % for chronic rejection (CR) and 4.5 % for acute rejection. Only 3 grafts (1.9 %) were lost because of CR. No risk factors have been identified for the development of CR after steroid withdrawal, but a protective role for azathioprine has been suggested.