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

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http://www3.interscience.wiley.com/cgi-bin/abstract/117947217/ABSTRACT?CRETRY=1 & SRETRY=0

Liver Transplantation

Volume 14, Issue 4 , Pages 512 - 525

Original Articles

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

Dorry L. Segev 1 *, M. Sozio 2, Eun Ji Shin 2, na M. Nazarian 1, Hari 1, J. Thuluvath 2, A. Montgomery 1, M. Cameron 1, Warren R. Maley 1

1Department of Surgery, The s Hopkins University School of Medicine, Baltimore, MD2Department of Medicine, The s Hopkins University School of Medicine, Baltimore, MD

email: Dorry L. Segev (dorry@...)

*Correspondence to Dorry L. Segev, Director of Clinical Research, Transplant Surgery, s Hopkins Medical Institutions, 600 N Wolfe St, Harvey 611, Baltimore, MD 21287Telephone: ; FAX:

Funded by: NIH Roadmap Multidisciplinary Clinical Research Career Development Award; Grant Number: NIH K12RR023266 NIH Clinical Research Scholars Program; Grant Number: NIH K12RR017627

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. Liver Transpl 14:512-525, 2008. © 2008 AASLD.

Received: 25 July 2007; Accepted: 10 October 2007

Digital Object Identifier (DOI)10.1002/lt.21396 About DOI