One third of kidney transplant (KT) recipients currently undergo early steroid withdrawal (ESW). Although ESW may slightly increase the risk of rejection in certain subgroups, it reduces steroid-induced side effects, such as diabetes and bone disorders. We hypothesized that ESW would also reduce the risk of infections after KT.

Methods: Using USRDS, we studied 58,502 kidney transplant recipients with Medicare as primary payer in 1999-2013. We built multivariable Cox models to examine the hazards of post-transplant infections and infection-related death in those undergoing early steroid withdrawal (ESW) versus conventional steroid treatment (CST), and whether these associations varied by their induction agent.

Results: Overall, 11,688 (20.0%) underwent ESW. This proportion varied by induction agent: 28.2% of those receiving ATG underwent ESW, 10.9% of those receiving IL2 receptor antagonists, and 14.2% of those not receiving induction. ESW was associated with significantly lower hazards of most infections and infection-related death (Table). When stratified by induction agent, the association of ESW with lower infection risk was significant in the ATG group, and similar trends were observed in the other groups, which were smaller in size (Table). The hazard ratios were comparable across all three groups and there was no statistically significant interaction between ESW and induction for most outcomes.

Conclusion: Early steroid withdrawal is associated with lower risk of infections and infection-related death, regardless of which induction agent is used.

CITATION INFORMATION: Bae S, Durand C, Kucirka L, DiBrito S, Avery R, Garonzik Wang J, Segev D. Early Steroid Withdrawal and Infection in Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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