From the Guidelines
Prednisolone is generally preferred over prednisone for liver transplant patients, including those undergoing IVF, as it is the active form of the medication that works directly in the body, whereas prednisone must first be converted by the liver into prednisolone to become active. This is particularly important in liver transplant patients, as the liver's ability to convert prednisone to prednisolone may be impaired 1. The use of corticosteroids, such as prednisone or prednisolone, is generally given in large doses during the first week after liver transplant and tapered rapidly to low levels or completely eliminated within weeks or months following transplant 1.
In the context of liver transplant patients, the management of immunosuppressive medications, including corticosteroids, is crucial to prevent acute rejection and manage potential adverse effects 2. The choice between prednisone and prednisolone may depend on individual patient factors, such as liver function and the presence of autoimmune liver diseases or recurrent rejection. However, prednisolone is generally considered a more reliable option due to its direct action in the body.
Key considerations for the use of prednisolone in liver transplant patients include:
- The potential for impaired liver function to affect the conversion of prednisone to prednisolone
- The need for careful monitoring of immunosuppressive medication levels and liver function tests
- The importance of minimizing the use of corticosteroids to reduce the risk of long-term side effects, such as cardiovascular disease, renal failure, infection, or malignancy 2
- The potential benefits of prednisolone in reducing inflammation and improving implantation rates in patients undergoing IVF, particularly those with recurrent implantation failure or autoimmune issues.
From the Research
Comparison of Prednisone and Prednisolone in Liver Transplantation
- The choice between prednisone and prednisolone in liver transplantation depends on various factors, including liver function and the patient's ability to convert prednisone to prednisolone 3.
- A study published in 1980 found that patients with liver cirrhosis had impaired conversion of prednisone to prednisolone, suggesting that prednisolone may be a better choice for these patients 3.
- In contrast, a study published in 2001 found that corticosteroids can be completely avoided from the beginning after liver transplantation, using a combination of tacrolimus and mycophenolate mofetil 4.
- Another study published in 2024 found that prednisone avoidance can be effective in patients with liver transplant, depending on the combination of other immunosuppressants administered 5.
- A study published in 1999 found that successful withdrawal of prednisone after adult liver transplantation for autoimmune hepatitis is possible, with 68% of patients being successfully withdrawn from corticosteroids 6.
- A study published in 1997 found that prednisone withdrawal 14 days after liver transplantation with mycophenolate is possible, with a moderate rejection rate and no immunologic graft losses 7.
Key Findings
- Prednisolone may be a better choice than prednisone for patients with impaired liver function 3.
- Corticosteroids can be completely avoided from the beginning after liver transplantation using a combination of tacrolimus and mycophenolate mofetil 4.
- Prednisone avoidance can be effective in patients with liver transplant, depending on the combination of other immunosuppressants administered 5.
- Successful withdrawal of prednisone after adult liver transplantation for autoimmune hepatitis is possible 6.
- Prednisone withdrawal 14 days after liver transplantation with mycophenolate is possible, with a moderate rejection rate and no immunologic graft losses 7.