Liver transplant patients who taper off or do not take corticosteroids after transplantation have better quality of life
Patients who undergo liver transplants show improved quality of life when they receive a drug regimen of immunosuppressant drugs that prevent organ rejection, and also reduce or avoid using corticosteroids for immune suppression, according to a new study. Corticosteroid treatment, used since the beginning of liver transplantation to prevent transplant rejection, can cause both physical problems, such as increased infections and metabolic disturbances, and mental health problems, including insomnia and behavioral and mood disturbances.
Newer antirejection protocols allow clinicians either to taper patients off corticosteroids or avoid their use altogether. To establish the impact of this approach on health-related quality of life (HRQOL), the researchers followed 186 adult patients who received liver transplants. They evaluated their HRQOL before transplantation and at least once after the procedure—for a median of 14 months and up to 6 years after transplantation. Most of the patients (81 percent) had post-transplant HRQOL reported at least twice, depending on the length of followup.
High-dose steroid use (at least 10 mg/day of prednisone or prednisone equivalents) following transplantation was significantly associated with lower scores on the physical component survey (PCS) and mental component survey (MCS), which contribute to a lower overall HRQOL for the patient.
High-dose steroid use was also associated with a significant increase in post-transplant anxiety, but not depression. Values for PCS, MCS, and anxiety at 1 year after transplantation were significantly better when patients were not on steroids than when patients were maintained on high-dose steroids. The researchers recommend the reduction or elimination of corticosteroids from post-transplant maintenance therapy. The findings were based on retrospective analysis of patients who underwent liver transplants at the Vanderbilt University Medical Center from 2002 through 2009. This study was funded in part by a grant from the Agency for Healthcare Research and Quality (T32 HS13833).
More details are in "Reduction in corticosteroids is associated with better health-related quality of life after liver transplantation," by Victor Zaydfudim, M.D., M.P.H., Irene D. Feurer, Ph.D., Matthew P. Landman, M.D., M.P.H., and others in the February 2012 Journal of the American College of Surgeons 214(2), pp. 164-173.
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