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World J Gastroenterol. Aug 21, 2014; 20(31): 10703-10714
Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10703
Corticosteroid-free immunosuppression in liver transplantation: An evidence-based review
George Sgourakis, Georgia Dedemadi
George Sgourakis, 2nd Surgical Department and Surgical Oncology Unit, “Korgialenio-Benakio” Red Cross Hospital, 15451 Athens, Greece
Georgia Dedemadi, Surgical Department of “Amalia Fleming” General Hospital, 15127 Athens, Greece
Author contributions: Sgourakis G designed the review; Sgourakis G and Dedemadi G performed the review of the literature, initial preparation of the paper and analyzed the data; Sgourakis G prepared the final version of the manuscript.
Correspondence to: George Sgourakis, MD, PhD, FACS, 2nd Surgical Department and Surgical Oncology Unit, “Korgialenio-Benakio” Red Cross Hospital, 11 Mantzarou Street, Neo psychiko, 15451 Athens, Greece. ggsgourakis@yahoo.gr
Telephone: +30-694-7690163 Fax: +30-210-6716015
Received: September 26, 2013
Revised: February 8, 2014
Accepted: April 21, 2014
Published online: August 21, 2014
Processing time: 327 Days and 18.9 Hours
Core Tip

Core tip: Steroid replacement in orthotopic liver transplantation results in fewer cases of overall acute rejection in the corticosteroid free-immunosuppression arm. Tacrolimus monotherapy is a feasible immunosuppression regimen without steroid replacement, although further investigations are needed in view of chronic rejections. No significant differences were noted between the treatment groups in terms of patient and graft survival independently of steroid replacement. Male gender, living donors, cold ischemia times, acute rejection, and early histological recurrence are related to the development of advanced hepatitis. There is sufficient evidence advocating avoidance of the ab initio use of steroids in orthotopic liver transplantation.