Corticosteroids usage in pediatric liver transplantation: To be or not to be!

Authors: Al-Sinani, Siham; Dhawan, Anil

Source: Pediatric Transplantation, Volume 13, Number 2, March 2009 , pp. 160-170(11)

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Abstract:

Al-Sinani S, Dhawan A. Corticosteroids usage in pediatric liver transplantation: To be or not to be!

The theoretical risks of early SW, <3 months post-LT, and complete elimination (steroid-free LT) lie in mainly three areas, namely the risks of AGR, CGR, and the development of d-AIH that has been described in SW post-LT in children. These should be balanced against the benefits of early SW mainly manifested as effects on growth post-LT. In this paper, we focused on the clinical trials that included CS therapy risks and benefits in pediatric LT. Focusing mainly on CGR and d-AIH as risks, and the beneficial effects on growth post-LT with either low-dose CS, SW, or steroid-free regimens. Main conclusions from comparing a large number of studies are: early SW or elimination from immunosuppression protocols was neither harmful to the patient nor to the graft survival rate in the short term, the overall impression is that steroids negatively affect growth in LT recipients when used in high doses and prolonged course, and that development of d-AIH is not associated with CS therapy with evidence that chronic low dose steroids post-LT have no preventative role against d-AIH.

Keywords: corticosteroids; immunosuppression; liver transplantation; de novo-autoimmune hepatitis; growth post-liver transplantation

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1399-3046.2008.01043.x

Publication date: 2009-03-01