Long-term steroids safe after transplant for autoimmune hepatitis

By Laura Newman

NEW YORK (Reuters Health) - Long-term corticosteroids combined with other immunosuppressive drugs may safely help lower the risk of recurrent autoimmune hepatitis (AIH) after liver transplant, according to a new study.

The team, led by Dr. Ye Htun Oo of Queen Elizabeth Hospital Birmingham, UK, analyzed data on 73 patients who underwent liver transplantation at their center for AIH between 1999 and 2014.

The authors changed their steroid regimen after 1999 because of a 27% rate of AIH recurrence at an average of 29 months after transplant.

"Following our observation of high rates of AIH recurrence, the unit protocol was modified to maintain prednisolone at a dose of 5-10 mg/day indefinitely, together with additional immunosuppressive agents and bone protection, in all AIH post-transplant recipients," they write.

Four of the 73 patients died within 90 days of transplant, before a long-term regimen could be established. Nearly two-thirds of the remaining patients were on triple immunosuppression (prednisolone, tacrolimus and one of three other drugs), while a third received dual immunosuppressive therapy.

Prednisolone was used for maintenance in 87% of patients. Corticosteroids were stopped in nine (13%) patients because of side effects, including infections, morbid obesity, hyperlipidemia and patient preference.

Survival rates at one, three, five and ten years were 92%, 90%, 86% and 73%, respectively, while graft survival was 86%, 81%, 78% and 64%. Nine patients needed re-transplantation, including four of seven patients with type 2 AIH.

Sepsis and osteoporosis were no more frequent than in other studies of liver recipients, the researchers wrote in Liver Transplantation, online September 3.

Sepsis occurred in a third of patients at least six months after transplantation. Pneumonia was the most common and most lethal infection, contributing to four of five deaths more than six months post-transplantation. Gastroenteritis and cholangitis were the most frequent recurring infections.

"In conclusion, our protocol of low dose corticosteroids in combination with other immunosuppressive agents seems to reduce the recurrence of AIH without jeopardizing patient and graft survival," the researchers write, adding that their findings need to be validated in a randomized clinical trial.

The authors did not respond to requests for comment.

Dr. Patricia Sheiner, Director of Transplant at Hartford Hospital in Hartford, Connecticut, told Reuters Health by email, "This article is interesting in that they demonstrate a very low rare of AIH recurrence after transplant."

"Most transplant physicians would agree that patients with AIH should be maintained on low dose steroids after transplant," she said.

But, she added, "Prolonged steroid use has been shown to have an increased rate of diabetes which is not looked at in this study. The incidence of diabetes would be interesting to know."

SOURCE: http://bit.ly/1MviUcv

Liver Transpl 2015.

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