Impact of steroid-avoidance immunosuppression on long-term outcome after liver transplantation for HCV cirrhosis: the need for well documented long-term follow-up.
Détails
ID Serval
serval:BIB_7FF1AADB2D21
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Impact of steroid-avoidance immunosuppression on long-term outcome after liver transplantation for HCV cirrhosis: the need for well documented long-term follow-up.
Périodique
Acta Gastro-enterologica Belgica
ISSN
0001-5644 (Print)
ISSN-L
0001-5644
Statut éditorial
Publié
Date de publication
2012
Volume
75
Numéro
4
Pages
411-418
Langue
anglais
Notes
Publication types: Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov'tPublication Status: ppublish
Résumé
AIM: study impact of steroid avoidance on HCV recurrence after transplantation.
METHODS AND MATERIAL: 35 HCV pats, being part of prospective, randomized, double-blind, placebo-controlled study comparing Tacrolimus (TAC)-Placebo (PLAC) (n = 14) to TAC-short-term (2 mo) low-dose steroid (STER) (n = 21), had 5 years follow-up. Primary endpoint was 1 and 5 years survival; secondary (composite) endpoint comprised HCV related cirrhosis, re-transplantation (re-LT) and death.
RESULTS: 1 and 5-years survival were 93% and 75% in TAC-PLAC group; 91% and 66% in TAC-STER group (p 0.38). Two (14.3%) TAC-PLAC pats died due to HCV cirrhosis at 54 and 72 mo; 7 (33%) TAC-STER pats died due to cholestatic hepatitis at 5.8 and 9 mo, to cirrhosis at 18, 22, 34, 73 and 79 mo (p 0.20). Composite endpoint at 5 years didn't show advantage in favor of TAC-PLAC patients (5/14 [35.7%] vs. 9/21 [42.8%] pts, p.0.69). Early biopsies seemed more favorable in TAC-PLAC pats; at 5 years results were identical for both groups. Only 1 (7.1%) TAC-PLAC and 2 (9.5%) TAC-STER pats needed rejection treatment.
CONCLUSION: immunosuppression using steroid avoidance or short-term use had similar outcomes. Well documented long-term follow-up, including biopsies, is necessary in order to make conclusions in relation to impact of steroid use on outcome of HCV liver recipients.
METHODS AND MATERIAL: 35 HCV pats, being part of prospective, randomized, double-blind, placebo-controlled study comparing Tacrolimus (TAC)-Placebo (PLAC) (n = 14) to TAC-short-term (2 mo) low-dose steroid (STER) (n = 21), had 5 years follow-up. Primary endpoint was 1 and 5 years survival; secondary (composite) endpoint comprised HCV related cirrhosis, re-transplantation (re-LT) and death.
RESULTS: 1 and 5-years survival were 93% and 75% in TAC-PLAC group; 91% and 66% in TAC-STER group (p 0.38). Two (14.3%) TAC-PLAC pats died due to HCV cirrhosis at 54 and 72 mo; 7 (33%) TAC-STER pats died due to cholestatic hepatitis at 5.8 and 9 mo, to cirrhosis at 18, 22, 34, 73 and 79 mo (p 0.20). Composite endpoint at 5 years didn't show advantage in favor of TAC-PLAC patients (5/14 [35.7%] vs. 9/21 [42.8%] pts, p.0.69). Early biopsies seemed more favorable in TAC-PLAC pats; at 5 years results were identical for both groups. Only 1 (7.1%) TAC-PLAC and 2 (9.5%) TAC-STER pats needed rejection treatment.
CONCLUSION: immunosuppression using steroid avoidance or short-term use had similar outcomes. Well documented long-term follow-up, including biopsies, is necessary in order to make conclusions in relation to impact of steroid use on outcome of HCV liver recipients.
Mots-clé
Adrenal Cortex Hormones/administration & dosage, Adrenal Cortex Hormones/adverse effects, Adult, Aged, Antiviral Agents/administration & dosage, Antiviral Agents/adverse effects, Biopsy, Double-Blind Method, Female, Graft Rejection/immunology, Graft Rejection/pathology, Graft Survival/drug effects, Graft Survival/immunology, Hepatitis C/complications, Hepatitis C/immunology, Humans, Immunosuppression/adverse effects, Immunosuppression/methods, Immunosuppressive Agents/administration & dosage, Immunosuppressive Agents/adverse effects, Liver Cirrhosis/etiology, Liver Cirrhosis/surgery, Liver Transplantation/immunology, Liver Transplantation/methods, Male, Middle Aged, Monitoring, Immunologic/methods, Secondary Prevention, Survival Analysis, Tacrolimus/administration & dosage, Tacrolimus/adverse effects, Time, Treatment Outcome
Pubmed
Web of science
Création de la notice
26/01/2015 12:35
Dernière modification de la notice
20/08/2019 15:40
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