The elimination of steroids — and their accompanying side effects — following organ transplantation may be possible, according to studies presented in early May at Transplant 2001, the annual meeting of the American Society of Transplantation and the American Society of Transplant Surgeons.
* James D. Eason, MD, of the Ochsner Multi-Organ Transplant Center (www.ochsner.org) in New Orleans said that steroid-free treatment using low-dose rabbit antithymocyte globulin (Thymoglobulin) may decrease the risk of diabetes, infection, and hepatitis C and may decrease the incidence of rejection among patients who have undergone liver transplantation.
In a study of 71 patients, half received Thymoglobulin and half received steroid therapy. All received a combination maintenance regimen of tacrolimus and mycophenolate mofetil. Four percent of the steroid-free patients and 14% of the steroid-treated patients developed posttransplantation diabetes. Also, 50% of the steroid-free patients and 70% of the steroid-treated patients developed recurrent hepatitis C. Acute rejection occurred in 20% of patients treated with Thymoglobulin and 30% of those who received steroids.
* In a study conducted at Northwestern University Medical School (www.nums.nwu.edu) in Chicago, simultaneous pancreas-kidney transplant recipients who stopped steroid treatment shortly after surgery had fewer rejections than those who continued with long-term steroid use. A group of 32 patients received a two-week course of Thymoglobulin after transplantation and steroids for six days. Another 87 patients received either horse antithymocyte globulin or a monoclonal anti-T cell antibody and continued on a permanent steroid treatment regimen. After six months, rejection rates were 3% (1 of 32) in the former group and 14% (12 of 87) in the latter group.
"With steroid-free protocols, we hope to reduce steroid-related side effects and costs for patients who require life-long immunosuppressive therapy to maintain their transplanted organs," said Northwestern's Dixon B. Kaufman, MD, PhD.
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