Kim, Young-Kyu; Lee, Kwang-Woong; Kim, Seong Hoon; Cho, Seong Yeon; Han, Sung-Sik; Park, Sang-Jae
World journal of surgery
2012Oct ; 36 ( 10 ) :2443-8.
PMID : 22674089
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Kim, Young-Kyu -
Lee, Kwang-Woong -
Kim, Seong Hoon -
Cho, Seong Yeon -
Han, Sung-Sik -
Park, Sang-Jae -
ABSTRACT
BACKGROUND: Steroid use after liver transplantation is known to increase the risk of new-onset diabetes mellitus (NODM). In this study, we tried to identify a patient subgroup who would benefit with regard to NODM by an early steroid withdrawal regimen (ESWR) after living donor liver transplantation (LDLT)
METHODS: Among 100 adult LDLT patients, 65 were on a conventional immunosuppressive regimen (CIR), and 35 were on an ESWR. With the ESWR, the steroid was tapered off mostly within 7 days with induction of basiliximab in combination with tacrolimus and mycophenolate mofetil (MMF). The CIR was a combination of tacrolimus and steroid. MMF was added in selected patients. Steroid was tapered off 2-6 months after LT. The presence of NODM was investigated cross-sectionally 6 months after LT.
RESULTS: There was no significant difference in terms of acute cellular rejection, sepsis, or death during follow-up. NODM had developed in 13 patients (13 %). Old recipient age (>/= 55) and pretransplant history of hypertension were significant risk factors for NODM. The type of immunosuppression was the single risk factor for NODM in subgroup of old-age recipients (>/= 55 years) on the CIR (hazard ratio 13.34, p = 0.04).
CONCLUSIONS: ESWR can safely reduce the incidence of NODM after LDLT in old-age recipients. Therefore, ESWR should be considered first in old-age recipients undergoing LDLT.
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MESH
Cross-Sectional Studies, Diabetes Mellitus/*prevention & control, Female, Glucocorticoids/*administration & dosage, Humans, *Liver Transplantation, *Living Donors, Male, Methylprednisolone/*administration & dosage, Middle Aged, Postoperative Complications/*prevention & control, Time Factors, Withholding Treatment
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