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Steroid Withdrawal Accelerates Bone Mass Recovery After Successful Liver Transplantation

Withdrawing prednisone from immunosuppressive treatment accelerates bone mass recovery following successful liver transplantation.

Previous studies have suggested a major role for glucocorticoids in transplantation related osteopenia, according to investigators from the Liver Transplantation Unit at the Hospital Universitario 12 de Octubre in Madrid, Spain.

The investigators studied 20 female and 49 male non-osteoporotic patients who underwent orthotopic liver transplantation. Twenty-eight patients received immunosuppressive treatment of prednisone, cyclosporin A and azathioprine. Prednisone dose was tapered off and withdrawn after 36.2 ± 19.3 months in 41 patients. Total follow-up was for an average of 58.3 ± 23.2 months.

Dual-energy X-ray absorptiometry was used to measure bone mineral density in the spine at baseline, before withdrawal of prednisone and at the end of the study. Age- and sex-matched bone mineral density Z-scores were calculated.

Bone mineral density significantly increased in both groups, increasing by 8.1 ± 8.7 percent in the prednisone withdrawal group and by 3.2 ± 8.0 percent in the standard treatment group. Bone mineral density Z-score was, however, significantly higher in the prednisone withdrawal group.

Improvements in bone mass density were independent of the time since orthotopic liver transplantation and the time since steroid withdrawal.

The investigators conclude that withdrawal of steroids from immunosuppressive treatment accelerates bone mass recovery after liver transplantation.
Osteoporos Int 2002; 13(2): 147-150. "Long-Term Follow-up of Bone Mass after Orthotopic Liver Transplantation: Effect of Steroid Withdrawal from the Immunosuppressive Regimen"

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