*Purpose: This study sought to assess the safety of steroid-containing maintenance immunosuppression in the setting of alemtuzumab (ALEM) induction.

*Methods: Adult (>18 years) kidney transplant recipients (KTR) transplanted 1/1/2015-12/31/2017 who received ALEM induction were included. Data was collected for the first post-transplant year. Per institution protocol, steroids are discontinued on post-operative day (POD) 4 in all KTR receiving ALEM induction, except patients with a panel of reactive antibody ≥30%, an acceptable reactive crossmatch, prior KTR, and delayed graft function. Cohorts were stratified into 2 groups according to those maintained on steroids at POD 37 (steroids vs steroid-free). The primary outcome was the incidence of proven or treated presumed infection (infx) within 12 months post-transplant.

*Results: Total of 445 KTR were included (Table 1), 189 steroid and 256 steroid-free. Patients maintained on steroids had higher incidence of infx (67.2% vs 56.3%, p=0.019), driven primarily by bacterial infx (55.6% vs 37.9%, p<0.001). Patients maintained on steroids also had higher mean number of overall hospitalizations (1.3±1.9 vs 0.86±1.3, p=0.007), and hospitalization secondary to infx (0.67±1.2 vs 0.38±0.8, p=0.005). Time to hospitalization was significantly lower in the steroids group (Figure 1). No difference was seen in new onset diabetes, weight change, and LDL. The steroid group had a lower mean eGFR at 12 months (53.22±17.4 vs 57.51±17.2, p=0.015). Similar rates of rejection, graft loss, and death were seen between groups.

*Conclusions: Infx and hospital admissions are higher amongst KTRs maintained on steroids post-ALEM induction compared with steroid-free patients, but do not exhibit a higher incidence of rejection, graft loss, or death. Consider limiting maintenance steroids in the setting of ALEM induction, especially in those patients at higher risk for infection.

« Back to 2020 American Transplant Congress