Purpose: Significant variation in maintenance immunosuppression (mIS) regimens has been described between transplant centers for simultaneous liver kidney (SLK) transplant recipients; we sought to describe this variation and explore the post-transplant outcomes associated with various regimens.

Methods: We studied 6262 adult SLK recipients using Scientific Registry of Transplant Recipients data from Mar 2002 – Feb 2017. We characterized mIS regimens at discharge and at one year post-transplant. We evaluated the association between regimen at 1 year and mortality and graft failure using Cox proportional hazard models, adjusting for patient and donor-specific characteristics.

Results: Triple therapy consisting of tacrolimus, steroids, and an antimetabolite was the most common initial regimen, but the proportion of patients on this regimen decreased over time in favor of steroid-sparing regimens. At 1 year, 90% of patients were on a tacrolimus based regimen. Compared to triple therapy, use of a steroid sparing tacrolimus and antimetabolite regimen at 1 year was associated with a 25% decreased risk of patient mortality (aHR: 0.75; 95% CI: 0.62-0.91, p = 0.003) without increased risk of kidney or liver graft failure. Use of a tacrolimus and steroid combination regimen had an increased risk of mortality compared to triple therapy, though not statistically significant (aHR 1.21, 95% CI: 0.99-1.48, p = 0.07).

Conclusions: Though nearly 70% of SLK recipients are placed on triple maintenance immunosuppression therapy initially, there is considerable variation in how immunosuppression is managed thereafter. Many patients transition to a steroid-sparing regimen with improved mortality without compromising graft loss.

CITATION INFORMATION: Weeks S., Luo X., Song C., Pote L., Gurakar A., Navqi F., Philosophe B., Cameron A., Desai N., Ottmann S., Segev D., Garonzik Wang J. Steroid Sparing Maintenance Immunosuppression is Associated with Decreased Mortality after Simultaneous Liver Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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