Division of Gastroenterology and Hepatology, University of Colorado, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
Liver Transpl. 2018 Aug;24(8):1109-1112. doi: 10.1002/lt.25206.
Corticosteroids have been a mainstay of immunosuppression following liver transplantation. However, evolution in the field of transplant immunology has produced steroid-free options, resulting in most transplant centers weaning steroids after transplant within days to months-an evidence-based management decision. Patients with autoimmune hepatitis (AIH), however, receive corticosteroids prior to transplant. This raises the question of whether these patients should also be weaned from corticosteroids. In this review, we discuss the benefits of avoiding steroid use in this population of patients-an approach that not only avoids the adverse effects of corticosteroids but does so without risking graft failure from recurrent AIH or from acute cellular rejection.
皮质类固醇一直是肝移植后免疫抑制的主要药物。然而,移植免疫学领域的发展产生了无类固醇的选择,导致大多数移植中心在移植后数天至数月内逐渐停用类固醇——这是一项基于证据的管理决策。然而,自身免疫性肝炎(AIH)患者在移植前接受皮质类固醇治疗。这就提出了一个问题,即这些患者是否也应该逐渐停用皮质类固醇。在这篇综述中,我们讨论了避免在这一人群中使用皮质类固醇的好处——这种方法不仅避免了皮质类固醇的不良反应,而且不会因复发的 AIH 或急性细胞排斥而导致移植物失功的风险。