背景：最近小肠移植后新免疫抑制方案推荐避免使用类固醇激素以防止其不良反应。我们根据我们的经验评估了类固醇激素对于存活率及移植后并发症的影响。患者和方法：在我们的回顾性分析中，我们考察了患者类固醇激素的每天平均剂量，共25名小肠/多脏器移植患者（最少随访时间为6个月）。我们分析了移植物和患者的生存率、排斥反应和感染事件的关系及类固醇激素的副反应。结果：在平均随访3年后，我们在我们的免疫抑制方案中没有发现在类固醇激素剂量上的显著性差异。平均强的松剂量超过20mg/d的患者移植物（p = 0.009）和患者（p = 0.02）生存率较低。移植后使用类固醇激素的副反应大致相同。使用类固醇激素患者更易引起感染（p = 0.04）。讨论和结论：类固醇激素治疗可能对于处理急性排斥反应有效，但是根据我们的经验高剂量激素的免疫抑制方案并不能改善移植物和患者的存活，反而增加感染率。我们建议除了一些特殊的病例外，在维持治疗中尽量避免高剂量的类固醇激素。

Background: Recently, new immunosuppressive protocols after intestinal transplantation have been proposed to avoid steroids use and their adverse effects. We evaluated the impact of steroids on survival and post-transplant complications in our experience. Patient and methods: In our retrospective study we considered the mean daily dosage of steroids received by 25 patients after intestinal/multivisceral transplantation (minimal follow-up was six months). We analyzed graft and patient survival rates, correlation with rejection and infectious episodes and steroids side effects. Results: After a mean follow-up of three yr, we did not find any significant difference in steroid doses between our immunosuppressive protocols. Patients with a mean dosage of prednisone higher than 20 mg/d experienced a lower graft (p = 0.009) and patient (p = 0.02) survival rate. The side effects of steroids after transplant were similar. Infections were more frequent during steroids administration (p = 0.04). Discussion and conclusion: Steroids therapy may be useful to treat acute rejection, but in our experience high steroids regimen did not improve graft and patient survival, increasing infectious rate. We assumed that high dose of steroids can be avoided as maintenance therapy, except in selected cases.

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