Early steroid withdrawal (ESW) has been a popular option for recipients with low-immunological risk. However, no quantitative tools are available to assess the risk, i.e. whether a given recipient is at sufficiently low risk for ESW. We aimed to empirically identify recipient subgroups for whom ESW is or is not appropriate.

Methods: Using SRTR data, we studied 87,681 deceased donor kidney transplant recipients between 2005-2014 who received a calcineurin inhibitor and anti-metabolite, with or without ESW. We built Cox models for all-cause graft loss, testing whether the impact of ESW varies by patient characteristics and induction regimen.

Results: Overall, ESW was associated with a lower hazard of graft loss (aHR=_0.900.94_0.98). The effect of ESW on graft loss varied by PRA, previous transplant, years on dialysis, delayed graft function (DGF), and donor serum creatinine (sCr). ESW was associated with a lower hazard of graft loss among recipients with PRA 0-80 (aHR=_0.880.92_0.96), but not among PRA>80 (aHR=_0.961.07_1.18). Similarly, ESW was associated with a lower hazard of graft loss among first-time recipients, preemptive recipients, recipients of kidneys with sCr>1.5mg/dl, and recipients with immediate graft function, but not among their counterparts (Table). When subgrouped by these factors (Figure), ESW was associated with particularly higher risk (aHR=_1.101.34_1.64) among recipients who had PRA>80 and experienced DGF (N=2669).

Conclusions: Recipients of preemptive transplant, grafts with sCr>1.5mg/dl, or immediately functioning grafts may be more appropriate for ESW. Those with PRA>80 or previous transplant may be less appropriate for ESW. These findings can assist evidence-based approaches for regimen choice.

CITATION INFORMATION: Bae S, Massie A, DiBrito S, Luo X, Kucirka L, Segev D. Clinical Factors That Determine the Appropriateness of Early Steroid Withdrawal. Am J Transplant. 2016;16 (suppl 3).

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