Steroid-free Immunosuppression In Liver Transplantation For Hepatocellular Carcinoma

Background:Glucocorticoid are commonly used in the immunosuppression therapy after liver transplantation (LT), but they are associated with considerable side effects like tumor recurrence, diabetes mellitus (DM), hypertension and so on. As we know, Hepatitis B virus (HBV) infection is an important factor that causes HCC in China. Retrospective study is designed to investigate the effects of immunosuppression without the use of glucocorticoid after LT for HCC.Methods:Sixty-six patients undergoing liver transplantation for HCC between December 2007 and February 2010 were randomized to receive immunosuppression with (steroid group,n=44) or without methylprednisolone (steroid-free group, n=22). The median follow-up of survivors was 12.6months (range:1.6-29.4 months). The study end points were to determine acute rejection. HCC recurrence, HBV recurrence, infectious complications, metabolic complications, liver function, and recipient survival. Results:The incidence of acute rejection was similar between steroid group and steroi-free group (15.9%vs 4.5%, P>0.05). The tacrolimus concentration in one week were higher in steroid group than in steroid-free group (9.08±0.57 ng/ml vs 4.61±1.01 ng/ml, P<0.01). Serum y-glutamyl transpeptidase (GGT) levels in two week, one month and serum alanine aminotransferase (ALT) levels in two week were higher in steroid group than in steroid-free group (239.49±30.22 U/L vs 130.50±26.92 U/L; 199.98±32.68 U/L vs 91.83±17.39; 209.42±46.81 U/L vs 62.05±11.90 U/L; P<0.05 for all). The plasma cholestasis concentration in one month was higher in steroid group than in steroid-free group(3.85±0.20 mmol/L vs 2.94±0.21 mmol/L, P<0.05). Lung Infection rate was higher in steroid group than that in steroid-free group (31.8%vs 9.1%, P<0.05). No differences were observed with regard to DM and hypertension. The six-month HCC recurrence and HBV recurrence rate were both similar in the two groups. Six-month survival rates and six-month tumor-free survival rates were similar (93.1%vs 87.5%,67.1%vs 85.6%, P>0.05 for both).Conclusion:1. Liver transplantation for HCC can be performed safely without using steroids in the postoperative course.2. Immunosuppression without steroids can reduce infection rate, the plasma concentration of cholestasis and high-density lipoprotein after LT. But its effect in diabetes and hypertension after LT should be further investigated.