Steroid avoidance in liver transplantation: Meta-analysis and meta-regression of randomized trials

Dorry L. Segev, Stephen M. Sozio, Eun Ji Shin, Susanna M. Nazarian, Hari Nathan, Paul J. Thuluvath, Robert A. Montgomery, Andrew M. Cameron, Warren R. Maley

Research output: Contribution to journalArticlepeer-review

Abstract

Steroid use after liver transplantation (LT) has been associated with diabetes, hypertension, hyperlipidemia, obesity, and hepatitis C (HCV) recurrence. We performed meta-analysis and meta-regression of 30 publications representing 19 randomized trials that compared steroid-free with steroid-based immunosuppression (IS). There were no differences in death, graft loss, and infection. Steroid-free recipients demonstrated a trend toward reduced hypertension [relative risk (RR) 0.84, P = 0.08], and statistically significant decreases in cholesterol (standard mean difference -0.41, P < 0.001) and cytomegalovirus (RR 0.52, P = 0.001). In studies where steroids were replaced by another IS agent, the risks of diabetes (RR 0.29, P < 0.001), rejection (RR 0.68, P = 0.03), and severe rejection (RR 0.37, P = 0.001) were markedly lower in steroid-free arms. In studies in which steroids were not replaced, rejection rates were higher in steroid-free arms (RR 1.31, P = 0.02) and reduction of diabetes was attenuated (RR 0.74, P = 0.2). HCV recurrence was lower with steroid avoidance and, although no individual trial reached statistical significance, meta-analysis demonstrated this important effect (RR 0.90, P = 0.03). However, we emphasize the heterogeneity of trials performed to date and, as such, do not recommend basing clinical guidelines on our conclusions. We believe that a large, multicenter trial will better define the role of steroid-free regimens in LT.

Original languageEnglish (US)
Pages (from-to)512-525
Number of pages14
JournalLiver Transplantation
Volume14
Issue number4
DOIs
StatePublished - Apr 2008

ASJC Scopus subject areas

  • Surgery
  • Hepatology
  • Transplantation

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