Background: Corticosteroids remain the cornerstone of maintenance immunosuppression following pancreas transplantation but are associated with significant short- and long-term complications. Data regarding steroid sparing regimens in pancreas transplants are limited. Only 35% of pancreas programs are steroid free, while others include long-term steroids in post-transplant maintenance protocols. Six and 12-month readmission rates following transplantation remain high, between 50-70% and result primarily from transplant related complications and infection. The purpose of this study was to assess if there is a difference in patient and graft outcomes between steroid free and steroid maintenance regimens in pancreas transplants.

Methods: This study queried the Scientific Registry of Transplant Recipients (SRTR) for patients identified as recipients of pancreas transplant alone (PTA) from January 2005 to March 2015. Primary endpoint was to analyze hospital readmission rates at 6 and 12 months for patients on maintenance steroids versus patients on steroid-free protocols. Secondary endpoints were rate of rejection, graft status and patient survival. Data were analyzed using Statistical Analysis Software.

Results: At 6 months, there were 974 patients who received PTA and had documented information in SRTR regarding hospitalizations and steroid use. Hospitalizations occurred during the first 6 months after transplant for 64.7% of patients in steroid-free group compared to 72.69% who received maintenance steroids (p=0.0075). At 12 months, there were 887 patients with documented information in SRTR regarding hospitalizations and steroid use. During this time period, steroid-free patients had less reported hospitalizations vs. steroid group (46.3% vs. 60.5%, p<0.0001). There was no difference in acute rejection rates between steroid free vs. steroid group at 6 months (N = 983, 16.6% vs. 16.2%, p = 0.8595) or 12 months (N=889, 9.30% vs. 7.57%, p = 0.3538). There was no difference between groups at 6 and 12 months in graft failure and patient mortality.

Conclusion: Our registry analysis suggests that maintenance steroids are associated with more hospitalizations in PTA recipients in the first 6 and 12 months while having no impact on acute rejection rates. However, study was limited by inconsistent reporting to SRTR. Additional research is needed to identify potential factors that increase rates of hospitalization in this population.

CITATION INFORMATION: Chan C, Tang I, Oberholzer J, Campara M. Outcomes Following Solitary Pancreas Transplantation – Do Steroids Matter? Am J Transplant. 2017;17 (suppl 3).

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