Background: Deceased donor orthotopic liver transplantation (OLT) can result in significant delayed function, manifesting as protracted hyperbilirubinemia, depending on the intensity of the ischemia/reperfusion injury (IRI). We recently changed our OLT protocol to include corticosteroid (CS) tapering post-transplant, as an anti-inflammatory agent against IRI.

Methods: We performed a retrospective cohort study of 208 OLTs performed at our center since 2002. We compared one-week post-OLT bilirubin levels between those that did and did not receive CS.

Results: The CS group consisted of 67 patients vs. 141 non-CS patients. Demographics were similar between the groups (table 1). Dosing of calcineurin inhibitors and antimetabolites was similar between the groups. One week median tacrolimus levels were slightly higher in the non-CS group vs. the CS group (7.0 ng/mL IQR (4.8-9.7) vs. 5.1 ng/mL IQR (3.0-7.8)). Median cold ischemia time (CIT) was shorter in the non-CS group vs. CS group (10 hours IQR (8.3-11.1) vs. 9.1 hours IQR (7.0-10.0), p = 0.02). Despite the shorter CIT, total bilirubin at 7 days post-OLT was increased in the non-CS group vs. the CS group (4.73 mg/dL IQR (2.1-11.2) vs. 2.21 mg/dL IQR (1.2-7.6), p = 0.001). Calculated MELD scores utilizing labs at one week were lower in the CS vs. non-CS group, likely related to the total bilirubin (non-CS = 15.2 vs. CS = 12.6, p = 0.02).

Conclusion: Our results suggest that the advantages of CS may extend beyond prevention of rejection. These findings should be confirmed in randomized studies to account for potential unmeasured confounders.

CITATION INFORMATION: Malat G., Reich D., Xiao G., Harhay M., Ranganna K., Lee D., Guy S., Munoz S. Adjunctive Corticosteroid Immunosuppression Improves Hyperbilirubinemia Following Liver Transplantation (OLT) Am J Transplant. 2017;17 (suppl 3).

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