Impact of steroid withdrawal on subclinical graft injury after liver transplantation : a propensity score-matched cohort analysis

Subclinical graft injuries in orthotopic liver transplantation may threaten long-term
graft survival and could be the result of chronic under-immunosuppression. It is
not known whether steroid withdrawal increases the risk of subclinical immune
responses against the graft. This retrospective single-center study aimed to
assess the risk of subclinical graft damage after steroid withdrawal within the
first nine months after orthotopic liver transplantation in the first three years
after transplantation in a prospective cohort of surveillance biopsies using a
propensity score matching analysis. Of 355 patients, 109 patients underwent
surveillance biopsies between eleven and 36 months after liver transplantation.
Thirty-seven patients discontinue steroids within the first nine months and 72
later than nine months after transplantation. The matching led to 28 patients per
group. Patients with autoimmune hepatitis, primary biliary cholangitis, and
hepatocarcinoma were excluded by the propensity score matching
unintentionally. Patients who discontinued steroids had a trend toward lower
levels of immunosuppression at the time of surveillance biopsy. Steroid
withdrawal in the first nine months was not associated with an increased risk of
subclinical T cell-mediated rejection, graft inflammation, or liver graft fibrosis in
the matched cohort with patients with a low frequency of autoimmune liver
diseases. There were also no differences in the development of metabolic
diseases. In conclusion, steroid withdrawal within the first nine months after
transplantation, as assessed by surveillance biopsies, does not increase the risk
of subclinical graft injuries or fibrosis at least in liver transplant recipient without
or a low prevalence of autoimmune liver diseases.