According to a new study, long-term use of glucocorticoids combined with other immunosuppressive drugs can help reduce the risk of recurrent autoimmune hepatitis (AIH) after liver transplantation.
The team led by Dr. Ye of the Queen Elizabeth Hospital in Birmingham, UK, analyzed data from 73 patients who underwent liver transplantation from AIH in 1999 to 2014.
After 1999, the authors changed their hormone regimens because the recurrence rate of AIH was 27% on an average of 29 months after transplantation.
“After we observed the high recurrence rate of AIH, the unit protocol was improved for all AIH recipients after transplantation, maintaining a prednisolone dose of 5-10 mg / day for long-term use, along with other immunosuppressive agents and bone Protect, “they wrote.
Four out of 73 patients died within 90 days of transplantation, before a long-term treatment regimen was established. The remaining 2/3 of the patients treated with triple immunosuppressive agents (prednisolone, tacrolimus and one of the three other drugs), and 1/3 received double immunosuppressive therapy.
Prednisolone was used for maintenance treatment in 87% of patients. Nine patients (13%) discontinued glucocorticoids due to side effects, including infection, morbidly obesity, hyperlipidemia and patient preferences.
Survival rates were 92%, 90%, 86%, and 73% for patients with 1, 3, 5, and 10 years, respectively, while graft survival rates were 86%, 81%, 78%, and 64%, respectively. Re-transplantation, including 7 patients with type 2 AIH in 4 cases.
Researchers in the “liver transplant” magazine September 3 online journal wrote that sepsis and osteoporosis occur without other studies of liver receptors frequently.
At least 1/3 of patients had sepsis six months after transplantation. Pneumonia is the most common and most deadly infection, accounting for 4/5 mortality after 6 months of transplantation, and gastroenteritis and cholangitis are the most common recurrent infections.
“In short, low-dose glucocorticoid-associated immunosuppressive agents may reduce AIH recurrence without affecting patient and graft survival,” the researchers wrote and added that their findings need to be performed in a randomized clinical trial verification.
“The interesting thing about this article is that they show a very low recurrence rate of AIH after transplantation,” said Dr. Patricia Sheiner, director of transplantation at Hartford Hospital, Connecticut, who told Reuters by e-mail.
“Most transplant doctors believe that AIH patients should use low-dose hormone maintenance therapy after transplantation,” she said.
However, she added, “Long – term use of hormones increases the incidence of diabetes, which is not seen in this study.