*Purpose: Basiliximab is a monoclonal antibody produced by recombinant DNA technology used by many transplant centers in the U.S. as induction immunosuppression. When Basiliximab is used, most of the patients are kept on maintenance steroids vs early steroid withdrawal in some centers. With this study, we seek to evaluate rejection, graft and patient survival rates among recipients who received Basiliximab and were maintained on steroids compared to early steroid withdrawal.

*Methods: We conducted a retrospective cohort analysis of the UNOS database. We identified all kidney transplant patients who received Basiliximab as induction therapy between January 2007 & December 2018. We divided the cohort based on whether they received steroids as part of maintenance immunosuppression or not, and compared risk factors of graft loss among them. Baseline donor and recipient characteristics were compared between groups using Student t-test or Kruskal Wallis test for continuous variables and Chi-2 test for categorical variables. Kaplan Meier curve and cox-regression analysis was used to measure graft and patient survival time.

*Results: A total of 33,914 patients who received Basiliximab induction were identified. Of them, 29,152 [85.9%] recipient received steroids as maintenance immunosuppression and 4,762 [14.0%] underwent early steroid withdrawal. Recipients kept on maintenance steroids had significantly higher acute rejection rate at one year post transplant compared to those who did not receive steroids [9.1% vs 8.0%, p=0.01]. However, kidney allograft failure rate at 5 years was significantly lower among patients who were on steroid maintenance compared to steroid-free [6.3% vs 7.3%, p=0.009]. Of the recipients who suffered graft failure, death censored graft survival time was significantly higher among the recipients who received steroids (p=0.009). Allograft survival advantage remained statistically significant after adjustment for age>70 years, delayed graft function, KDPI>85% and female donor. Finally, patient’s death rate at 5 year post transplant was significantly lower among the recipients who received steroids compared to the other group (9.1% vs 11.6%, p<0.001).

*Conclusions: In spite of higher rejection rates within the first year of transplant, kidney allograft survival rate was significantly higher among recipients who received Basiliximab induction and were maintained on steroids compared to recipients who underwent early steroid withdrawal. Patient survival was also significantly higher among patients maintained on steroids compared to early steroid withdrawal.

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