This report reviews the literature and discusses steroid withdrawal after hepatic transplantation. Our experience with steroid withdrawal is highlighted. The hypothesis is that steroid withdrawal from liver transplant recipients is safe and beneficial. A review of the English literature yielded 16 reports with a total of 901 patients (749 adults and 152 children). Most reports were nonrandomized and uncontrolled. Only two reports were randomized, controlled trials; three reports featured early steroid withdrawal (= 3 months); and one report featured very early steroid withdrawal (14 days). Steroid withdrawal was achieved in approximately 85% of the patients. Acute rejection was not significantly increased by steroid withdrawal; rates were 5% to 14% in uncontrolled trials and 7% versus 7% (late steroid withdrawal v control; P = not significant [NS]) and 4% versus 8% (early steroid withdrawal v control; P = NS) in controlled trials. Acute rejection rates after very early steroid withdrawal (14 days posttransplantation) were 42% to 46%, similar to or less than the 40% to 70% reported for steroid-containing regimens. Chronic rejection was not increased by steroid withdrawal; the rate was 3.9% in one uncontrolled trial and 0% versus 3% (early steroid withdrawal v control; P = NS) in one controlled trial. Patient and graft survival were not adversely affected. Steroid withdrawal was associated with reduced rates and better control of hypertension, reduced total cholesterol levels, reduced rate of posttransplantation diabetes mellitus, improved control of diabetes, and reduced rate of obesity. The aggregate experience with steroid withdrawal suggests it is safe, associated with improvement in several posttransplantation complications, and deserves broader clinical application.
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http://dx.doi.org/10.1053/JTLS005s00048 | DOI Listing |
World J Gastroenterol
January 2025
Department of Biochemistry and Molecular Biology, School of Basic Medical Sciences, Zhengzhou University, Zhengzhou 450001, Henan Province, China.
Background: Liver injury manifesting as hepatic enzyme abnormalities, has been occasionally identified to be a feature of primary or secondary Addison's disease, an uncommon endocrine disease characterized by adrenal insufficiency. There have been no more than 30 reported cases of liver injury explicitly attributed to Addison's disease. Liver injury resulting from adrenal insufficiency due to glucocorticoid withdrawal is exceptionally rarer.
View Article and Find Full Text PDFAnn Rheum Dis
January 2025
Rheumatology Center, Toulouse University Hospital, Toulouse, France.
Objectives: To compare two strategies-a hydrocortisone replacement strategy and a prednisone tapering strategy-for their success in glucocorticoid discontinuation in patients with rheumatoid arthritis (RA) with low disease activity (LDA).
Methods: The Strategies for glucocorticoid TApering in Rheumatoid arthritis (STAR) study was a double- blind, double-placebo randomised controlled trial including patients with RA receiving a stable dose of glucocorticoid 5 mg/day for ≥3 months and were in LDA for ≥3 months. Patients were randomly assigned in a 1:1 ratio to either replace prednisone with 20 mg/day of hydrocortisone for 3 months, then reduce to 10 mg/day for 3 months before discontinuation or to taper prednisone by 1 mg/day every month until complete discontinuation, contingent on maintaining LDA.
Sci Rep
January 2025
Center for Cancer Immunotherapy and Immunobiology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Menstrual pain affects women's quality of life and productivity, yet objective molecular markers for its severity have not been established owing to the variability in blood levels and chemical properties of potential markers such as plasma steroid hormones, lipid mediators, and hydrophilic metabolites. To address this, we conducted a metabolomics study using five analytical methods to identify biomarkers that differentiate menstrual pain severity. This study included 20 women, divided into mild (N = 12) and severe (N = 8) pain groups based on their numerical pain rating scale.
View Article and Find Full Text PDFContraception
January 2025
Division of Endocrinology, Department of Medicine, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California; Clinical and Translational Science Institute, The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California.
While there are several easy-to-use reversible female contraceptives, little is available for men. Introduction of novel, cost-effective male contraceptives could have important downstream global health and economic benefits. Currently, nearly half of all pregnancies globally are unintended, with many resulting in unsafe abortions, a significant burden for women and families in many countries.
View Article and Find Full Text PDFMagnes Res
January 2025
Research Group on Diabetes and Chronic Illnesses, Mexico., Mexican Social Security Institute, Durango, México.
Individuals with long-COVID exhibit a higher frequency of hypomagnesemia, vitamin D deficiency, and depression. Objective. To evaluate the efficacy and safety of oral supplementation with magnesium chloride plus vitamin D in alleviating depressive symptoms related to long-COVID.
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