Clinical

Pilot study suggests children may benefit by avoiding steroids after liver grafting

Last Updated: 2003-12-18 18:30:34 -0400 (Reuters Health)

NEW YORK (Reuters Health) - After liver transplantation, children seem to respond well to a combination of tacrolimus and basiliximab rather than tacrolimus and steroids, according to pilot study findings published in the December 20/27 issue of The Lancet. Growth catch-up occurred significantly earlier when steroids were avoided.

Lead author Dr. Raymond Reding at Saint-Luc University Clinics in Brussels, Belgium, and his team theorized that steroid use may increase the risk of infections, hypertension, hypercholesterolemia, stunted growth and immunological tolerance.

To analyze the potential of nonsteroidal treatment, they conducted a pilot study in which induction treatment with basiliximab, an anti-CD25 monoclonal antibody, replaced steroid administration. Twenty patients treated with the new regimen were compared with 20 historical controls.

Rejection-free graft survival was 90% at 6 months and 75% at 12 months in the basiliximab group, and 50% at both time points in the steroid group. At 12 months, three children in the test group and all 20 in the steroid group required steroids because of previous rejection episodes.

Fewer basiliximab-treated patients required antihypertensive medications during follow-up (p = 0.005) and growth was significantly better. Dr. Reding's group notes that their findings will require confirmation after extended follow-up before their new treatment regimen can be recommended.

Lancet 2003;362:2068-2070.