PREDNISONE WITHDRAWAL LATE AFTER ADULT LIVER-TRANSPLANTATION REDUCES DIABETES, HYPERTENSION, AND HYPERCHOLESTEROLEMIA WITHOUT CAUSING GRAFTLOSS

We prospectively withdrew prednisone in 28 adult patients who had stab le graft function more than 2 years after orthotopic liver transplanta tion (OLTx) and had been on 5 mg/d prednisone for at least 6 months. P rednisone was decreased from 5 mg/d to 2.5 mg/d for 1 month then stopp ed completely. Cyclosporine monotherapy was maintained at a level of a pproximately 200 ng/mL (TDX). Nineteen patients had prednisone withdra wn without complications. Four (14.2%) had modest elevations in liver function tests (two biopsy proven mild rejections and two were not bio psied). These four were treated with methylprednisolone boluses and th en withdrawal of steroids again. Prednisone was restarted in five pati ents because of generalized fatigue and body aches (n = 4) and colitis (n = 1). Steroids later were successfully withdrawn in two of these p atients, After prednisone withdrawal, three of five insulin-dependent diabetic patients were able to discontinue insulin therapy and their g lycosylated hemoglobin levels improved. Four of fourteen hypertensive patients were able to discontinue antihypertensive medicines. Mean ser um cholesterol decreased from 222.6 +/- 43.3 to 188.3 +/- 33.3 mg/dL ( P <.001). The number of patients with serum cholesterol levels > 220 m g/dL decreased from 13 to 4. A control group of 24 patients maintained on 5 mg/d prednisone at least 2 years after liver transplantation als o was studied. in this group during the study period, no diabetic beca me normoglycemic, no patient decreased their antihypertensive medicine , and the mean serum cholesterol levels did not change significantly. We conclude that prednisone withdrawal using cyclosporine monotherapy late after liver transplantation does not lead to graft loss and decre ases the prevalence of diabetes, hypertension, and hypercholesterolemi a. Symptoms occurring during withdrawal may be minimized by earlier or slower tapering.