Early Steroid Withdrawal After Pediatric Living Donor Liver Transplantation: Clinical Analysis Of 31 Cases

Objective: To evaluate efficacy and safety on early steroid withdrawal after pediatric living donor liver transplantation.Methods: The clinical data including 42 pediatric LDLT from Jun 2006 to Aug 2009 were analyzed retrospectively. Nine died during follow up period because of non-immune factors. The remaining 31 children were admitted to the research. Twenty two patients had identical ABO grafts, the rest 9 cases were ABO-compatible. Twenty eight were donor parents, and 2 were donor grandmother. They received intravenous methylprednisolone 10mg/kg during intraoperation, and CNIs (CsA&FK506) after LDLT, thirteen of them received MMF during follow up. They were received 1~1.5mg.kg-1q6h, 1~1.5mg. kg-1 q8h, 1mg.kg-1 q8h, 0.5~1mg.kg-1 q8h and 0.5mg.kg-1 q12h intravenous methylprednisolone tapered every 2 days from post operative day 1 to day 9, and thereafter received oral prednisone (10 mg daily for infants, 10~20mg daily for older children), and reduction to 5 mg daily after after remaining for 1month and maintained for 1 month. Steroid withdrawal was carried out progressively when the liver functions were normal and no acute rejection occurred. The clinical manifestation, serum biochemical and growth were followed-up closely. The incidence of treated acute rejection, side effects and affect to growth were evaluated. All recipients were followed up from 2 to 43 months (Median 14.3 months).Results: The mediam time of steroids wass 4.3 months (2~10months). At 3 months after LDLT, fourteen patients (45.2%)were steroid-free, six months was 28 patients (90.3%), and all patients were steroid-free 10 months after LDLT. Six acute rejection occurred during steroid withdrawal. The percentage of SW was higher in infants (three months after LDLT: 55.0% VS 36.3%; six months after LDLT: 100% VS 72.7%), Morbidity of rejection was lower in infants (15.0% VS 27.3% ), but it's not statistically significant(P> 0.05 ). There was no rejection episode after steroid withdrawal. Median height z-score in all patients increased to -0.61±0.96, there had three children who follow-up for two years had normal height.Conclusion: Steroid withdrawal could be achieved in most patients after pediatric LDLT, and it's safety and efficacy. The younger, more successful and safer. It's beneficial to the growth of children after LDLT.