*Purpose: Tacrolimus, mycophenolate mofetil, and chronic corticosteroids (CCS) are the most popular immunosuppression regimen after pancreas transplantation. Early corticosteroid withdrawal (ECSWD) is an increasingly popular immunosuppression modality. The purpose of this analysis is to compare long-term clinical and metabolic outcomes post-transplantation between ECSWD and CCS patients.

*Methods: Single-center retrospective cohort study of adult pancreas transplant or simultaneous pancreas-kidney transplant (SPK) from 1/1/1997 to 10/1/2010. Patients were excluded if there was < 6 months follow-up or if they experienced graft failure < 30 days post-transplant. The primary endpoint was to compare death-censored allograft survival 10 years post-transplant between CCS and ECSWD transplant recipients. Secondary efficacy endpoints compared rejection, metabolic parameters, and patient death at 5 and 10 years post-transplant.

*Results: 79 patients were analyzed (ECSWD n = 47; CCS n = 32). Demographics and transplant immunosuppression information are listed in Table 1. The 10-year death-censored allograft survival more favorable in the ECSWD group (p=0.03). Patient survival (p=0.57) did not differ at 10 years, and acute rejection was similar at 5 years (p=0.26) . Figure 1 details time to rejection, patient survival, and death-censored allograft survival. Hemoglobin A1C was significantly lower in ECSWD patients at 10-years (CCS 6.7% vs ECSWD 5.5%, p = 0.008) post-transplant. Metabolic outcomes are listed in Table 2.

*Conclusions: ECSWD yields similar long-term patient survival and rejection outcomes post-pancreas transplant and may provide improved metabolic profiles. Death-censored allograft survival was higher in the ECSWD patients. More research is warranted to compare immunosuppression modalities.

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