A randomized, multicenter study comparing steroid-free immunosuppression and standard immunosuppression for liver transplant recipients with chronic hepatitis C

作者：Klintmalm Goeran B^*; Davis Gary L; Teperman Lewis; Netto George J; Washburn Kenneth; Rudich Stephen M; Pomfret Elizabeth A; Vargas Hugo E; Brown Robert; Eckhoff Devin; Pruett Timothy L; Roberts John; Mulligan David C; Charlton Michael R; Heffron Thomas G; Ham John M; Douglas David D; Sher Linda; Baliga Prabhakar K; Kinkhabwala Milan; Koneru Baburao; Abecassis Michael; Millis Michael; Jennings Linda W; Fasola Carlos G

来源：Liver Transplantation, 2011, 17(12): 1394-1403.

DOI：10.1002/lt.22417

This randomized, prospective, multicenter trial compared the safety and efficacy of steroid-free immunosuppression (IS) to the safety and efficacy of 2 standard IS regimens in patients undergoing transplantation for hepatitis C virus (HCV) infection. The outcome measures were acute cellular rejection (ACR), severe HCV recurrence, and survival. The patients were randomized (1:1:2) to tacrolimus (TAC) and corticosteroids (arm 1; n = 77), mycophenolate mofetil (MMF), TAC, and corticosteroids (arm 2; n = 72), or MMF, TAC, and daclizumab induction with no corticosteroids (arm 3; n = 146). In all, 295 HCV RNApositive subjects were enrolled. At 2 years, there were no differences in ACR, HCV recurrence (biochemical evidence), patient survival, or graft survival rates. The side effects of IS did not differ, although there was a trend toward less diabetes in the steroid-free group. Liver biopsy samples revealed no significant differences in the proportions of patients in arms 1, 2, and 3 with advanced HCV recurrence (ie, an inflammation grade >= 3 and/or a fibrosis stage >= 2) in years 1 (48.2%, 50.4%, and 43.0%, respectively) and 2 (69.5%, 75.9%, and 68.1%, respectively). Although we have found that steroid-free IS is safe and effective for liver transplant recipients with chronic HCV, steroid sparing has no clear advantage in comparison with traditional IS. Liver Transpl, 2011.

• 出版日期2011-12