Corticosteroid withdrawal after orthotopic
liver transplantation (OLT) represents an attractive therapeutic option for ameliorating post-OLT metabolic complications, although several reports suggest patients who undergo
transplantation for
autoimmune hepatitis (AIH) may have a greater incidence of acute and chronic rejection when withdrawn from
corticosteroid therapy. The aim of this study is to evaluate the success of
corticosteroid withdrawal in patients with AIH after OLT. Twenty-six patients underwent successful OLT for AIH. In 21 of these patients, stable maintenance immunosuppression consisted of
cyclosporine (CSA) and
prednisone (n = 20) or
tacrolimus (TAC) and
prednisone (n = 1). In this group, a trial of
prednisone withdrawal was initiated when patients were 6 months or more post-OLT, with normal liver function, and receiving an average
prednisone dosage of 10 mg/d. Five additional patients treated with either TAC (n = 4) or CSA (n = 1) plus
mycophenolate mofetil underwent a 14-day taper of
prednisone. Overall, 17 of 25 patients (68%) were successfully withdrawn from
corticosteroids, with a mean follow-up of 22 months (range, 1 to 34 months). Of the remaining 8 patients, 5 patients received a lower dosage of
prednisone or required
prednisone to control
inflammatory bowel disease. Only 3 patients remained dependent on
prednisone to maintain stable liver allograft function. Withdrawal from 10 to 5 mg of
prednisone (n = 21) resulted in four episodes of
steroid-responsive and two episodes of
steroid-resistant rejection in 3 patients, and 18 of 21 patients (86%) were rejection free. Withdrawal from 5 to 0 mg
prednisone (n = 17) resulted in eight episodes of
steroid-responsive and no episodes of
steroid-resistant rejection in 4 patients; 13 of 17 patients (76%) were rejection free. Of the 5 patients in the 14-day
prednisone-taper group, 3 patients had
steroid-responsive rejection and 1 patient required
OKT3. Seventeen of 21 patients (81%) with AIH were successfully withdrawn from
corticosteroids. It is notable that
corticosteroid withdrawal was associated with a reduction in serum
cholesterol levels, decreased use of
antihypertensive agents, and reduced need for
insulin or oral
hypoglycemic agents. We propose
corticosteroid withdrawal should be attempted in patients with underlying AIH who undergo OLT because most will benefit without significantly jeopardizing the liver allograft.