Khalid Al-Ghamdi, Xiaoting You, Sameera Rizvi, Annabel Koivu, Shiyi Chen, Elmar Jaeckel, Mamatha Bhat
Budesonide was prescribed at a mean dose of 6.0 mg/d for a median of 23 months. While on budesonide, one patients (3.6%) developed biopsy-proven T-cell mediated rejection (TCMR) with no graft loss. Metabolic parameters remained stable despite being on long-term steroid therapy, with mean glycated hemoglobin (HbA1c) at 5.7%, body mass index (BMI) at 25.2 kg/m², and blood pressure at 122/77. There were 5 new cases of hypertension and no new diabetes diagnosis. Severe infectious complications occurred in 3 patients (10.7%). Bone health data were available for nine patients, with 4 new osteoporosis diagnosis (14.3%), CONCLUSION: Budesonide was well tolerated and was associated with preserved graft function and stable metabolic profiles in this real-world liver transplant cohort. These findings suggest the potential role of budesonide in steroid-dependent patient's post-liver transplantation.
BACKGROUND: Systemic corticosteroids, such as prednisone, are immunosuppressives used in induction protocol, rejection management, and steroid-dependent patients. However, corticosteroid use is associated with metabolic and infectious complications. Budesonide, a corticosteroid with high first-pass hepatic metabolism and low systemic bioavailability, may offer a safer alternative when long-term prednisone is required.
METHODS: We conducted a retrospective case series of 28 adult liver transplant recipients who required long-term corticosteroids and were started on budesonide at the University Health Network in Toronto from 2006 to 2024. Clinical data were extracted from EPIC and OTTR databases to evaluate safety, metabolic outcomes, graft function, and infection risk of budesonide.
RESULTS: Budesonide was prescribed at a mean dose of 6.0 mg/d for a median of 23 months. While on budesonide, one patients (3.6%) developed biopsy-proven T-cell mediated rejection (TCMR) with no graft loss. Metabolic parameters remained stable despite being on long-term steroid therapy, with mean glycated hemoglobin (HbA1c) at 5.7%, body mass index (BMI) at 25.2 kg/m², and blood pressure at 122/77. There were 5 new cases of hypertension and no new diabetes diagnosis. Severe infectious complications occurred in 3 patients (10.7%). Bone health data were available for nine patients, with 4 new osteoporosis diagnosis (14.3%), CONCLUSION: Budesonide was well tolerated and was associated with preserved graft function and stable metabolic profiles in this real-world liver transplant cohort. These findings suggest the potential role of budesonide in steroid-dependent patient's post-liver transplantation.