*Purpose: The purpose of this study is to assess the long-term efficacy and safety of early corticosteroid withdrawal (ESW) compared to corticosteroid maintenance (CCS) immunosuppression in patients following simultaneous pancreas-kidney (SPK) transplantation.

*Methods: This was a retrospective single-center matched comparison with the International Pancreas Transplant Registry (IPTR). Patients from the University of Illinois Hospital (ESW group) were compared to a matched IPTR cohort (CCS group). Adult primary SPK transplant recipients from 01/01/2003 to 12/31/2018 within the United States who received rabbit anti-thymocyte globulin induction were included. Those with early technical failures, missing steroid data, graft thrombosis, repeat transplant, or positive crossmatch were excluded. Patients were matched on transplant era, recipient and donor age and gender, recipient race, HLA mismatch, dialysis status pre-SPK, center volume, and pancreas preservation time. Allograft and patient survival were compared between ESW vs CCS regimens. Immunologic allograft failure was defined as failure due to immunologic sequalae and censored out all other causes.

*Results: A total of 156 patients were analyzed. Demographics are demonstrated in Table 1. Patient and immunologic allograft survival were similar at 10 years post-SPK (Table 2). Allograft survival is demonstrated in Figure 1 and Figure 2. Five-year rejection rates were similar between ESW and CCS (p>0.05). Median hemoglobin A1c (5.3% vs 5.2%) and serum creatinine (1.5 vs 1.3 mg/dL) were similar at 5-years post-transplant.

*Conclusions: ESW and CCS regimens demonstrate similar allograft and patient survival up to 10 years post-transplant and similar rejection and allograft function outcomes up to 5 years post-transplant.

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