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Comparing Infection Rate Between Steroid Withdrawal and Ongoing Maintenance Among Simultaneous Pancreas-Kidney Transplant Recipients

M. McCord1, Z. Yetmar2, A. Lemke1, K. Mara3, M. T. Seville4, W. Bosch5, P. Dean6, E. Beam2, S. Bernard1

1Department of Pharmacy, Mayo Clinic, Rochester, MN, 2Division of Infectious Diseases, Mayo Clinic, Rochester, MN, 3Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, 4Division of Infectious Diseases, Mayo Clinic Arizona, Scottsdale, AZ, 5Division of Infectious Diseases, Mayo Clinic, Jacksonville, FL, 6Division of Transplantation Surgery, Mayo Clinic, Rochester, MN

Meeting: 2022 American Transplant Congress

Abstract number: 1156

Keywords: Glucocortocoids, Immunosuppression, Pancreas transplantation

Topic: Clinical Science » Pancreas » 65 - Pancreas and Islet: All Topics

Session Information

Session Name: Pancreas and Islet: All Topics

Session Type: Poster Abstract

Date: Sunday, June 5, 2022

Session Time: 7:00pm-8:00pm

 Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: Compare infection rates of simultaneous pancreas-kidney transplant (SPK) recipients who continue maintenance steroids to those with steroid withdrawal post transplant.

*Methods: This study is a single center retrospective cohort analysis comparing rates of infection between SPK recipients who continue maintenance steroids and those with steroid withdrawal. Included patients were SPK recipients from 2010 through 2020 at Mayo Clinic Arizona, Florida, or Rochester. The primary outcome was rate of any infection at 12 months post transplant. Secondary outcomes included rates of infection categorized by type (surgical site [SSI], cytomegalovirus [CMV], Clostridium difficile, invasive fungal [IFI], and other), rejection, and graft survival at 12 months post transplant. Event rates were calculated using the Aalen-Johansen method and were compared between groups by Cox proportional hazards regression.

*Results: 175 total patients were analyzed with 46 in the maintenance steroid and 129 in the steroid withdrawal groups. Baseline characteristics differed between cohorts regarding pancreas transplant indication, CPRA%, and incidence of pre-transplant Clostridium difficile and MRSA infections. Induction was predominantly anti-thymocyte globulin in the maintenance steroid group and alemtuzumab in the withdrawal group. The most observed infections included CMV (25.7%), SSI (17.7%), and uncomplicated cystitis (14.3%). The maintenance steroid group experienced higher rates of categorized infections (76.1% vs 58.9%, p=0.038), other infections (54.3% vs 24%, p<0.001), and pancreas graft loss (20% vs 8.2%, p=0.048) within 12 months. No difference between groups was found for rates of SSI, CMV, Clostridium difficile, IFI, rejection, or survival.

*Conclusions: Steroid withdrawal after SPK may lead to a reduction in infection rates within 12 months post transplant without increasing risk of allograft loss or rejection when compared to continued maintenance steroids. Larger studies are required to confirm this association.

Table 1: Outcomes at 12 months after transplant between steroid maintenance and withdrawal
Maintenance(N=46) Withdrawal(N=129) Total(N=175) p value
Categorized infections 35 (76.1) 76 (58.9) 111 (63.4) 0.038
Other infections 25 (54.3) 31 (24.0) 56 (32.0) <0.001
Pancreas graft loss 9 (20.0) 10 (8.2) 19 (11.5) 0.048
Renal graft loss 1 (2.2) 0 (0) 1 (0.6) 0.35
Pancreas ACR 10 (22.2) 40 (34.7) 50 (31.3) 0.15
Renal ACR 10 (22.2) 16 (16.2) 26 (18.2) 0.43
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To cite this abstract in AMA style:

McCord M, Yetmar Z, Lemke A, Mara K, Seville MT, Bosch W, Dean P, Beam E, Bernard S. Comparing Infection Rate Between Steroid Withdrawal and Ongoing Maintenance Among Simultaneous Pancreas-Kidney Transplant Recipients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/comparing-infection-rate-between-steroid-withdrawal-and-ongoing-maintenance-among-simultaneous-pancreas-kidney-transplant-recipients/. Accessed May 9, 2025.

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