Current guidelines suggest early steroid withdrawal (ESW) regimen for kidney transplant (KT) recipients with low immunological risk. Delayed graft function (DGF) is a risk factor for rejection, indicating high immunological risk. ESW may possibly be unsuitable for recipients with DGF. We investigated the association of ESW with graft failure and death among KT recipients with and without DGF.

METHODS: Using SRTR data, we studied 97,139 adult deceased-donor kidney-only recipients 2005-2016 who received immunosuppression regimens that included tacrolimus and mycophenolate. We conducted shared-frailty Cox regressions to compare the risk of death-censored graft failure and death by ESW and DGF.

RESULTS: Recipients with DGF were less likely to receive ESW maintenance compared to those without DGF (25.6% vs 30.4%; aOR=_0.690.72_0.75). Regardless of DGF status, those who received ESW had lower immunological risk (Table). After adjusting for clinical characteristics and center-level variation, ESW was associated with a lower risk of graft failure among those without DGF (aHR=_0.880.94_0.99) but not among those with DGF (aHR=_0.971.05_1.13; p-for-interaction=0.008; Figure). ESW was also associated with a lower risk of death among those without DGF (aHR=_0.860.90_0.94) but not among those with DGF (aHR=_0.900.96_1.03; p-for-interaction=0.08; Figure).

CONCLUSION: While ESW appears to be safe and effective for recipients without DGF, it might not confer the same benefits on those with DGF.

CITATION INFORMATION: Bae S., Massie A., Luo X., Garonzik Wang J., Segev D. Early Steroid Withdrawal and Kidney Transplant Outcomes for Recipients with Delayed Graft Function Am J Transplant. 2017;17 (suppl 3).

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