Comparing Infection Rate Between Steroid Withdrawal and Ongoing Maintenance Among Simultaneous Pancreas-Kidney Transplant Recipients
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 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.
|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|
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 March 26, 2023.
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