Steroids have been an important component of maintenance immunosuppression in solid organ transplant, but their adverse effect profile has led to the development of steroid withdrawal regimens. In pancreas transplant, steroid withdrawal regimens have been studied but long term data is lacking. The purpose of this study was to evaluate steroid withdrawal on patient and graft outcomes in pancreas transplant recipients at three years post-transplant.

Methods: We performed a retrospective chart review of adult patients who underwent a pancreas transplant at our center between May 1989 and October 2013. Maintenance immunosuppression consisted of tacrolimus, mycophenolate mofetil or sodium and prednisone until 2004 when a steroid withdrawal protocol was adopted. The primary outcome was the composite of graft survival, patient survival and rejection at three years post-transplant. Secondary outcomes include readmission rates at one month and three months post-transplant, immunosuppression levels, incidence of infection, and the number of patients who resumed prednisone in the steroid free group.

Results: A total of 123 pancreas transplant recipients were included, 70 patients continued steroids and 53 patients underwent steroid withdrawal. The study population consisted of male (57.7%) Caucasians (88.3%) at a mean age of 42.78 ± 7.25 years. There was no difference in the composite endpoint of patient death, graft loss or rejection between groups (steroid-based vs. steroid-free) at three years (36% vs. 28%, p=0.38). There was no difference between groups in readmission at one month (59% vs 66%, p=0.46) and three months (46% vs 45%, p=0.96). Tacrolimus troughs were not different between groups at any timepoint. The MMF dose was significantly lower in the steroid-free group at three years compared to the steroid group (1214mg vs. 1656mg, p=0.02). The total number of infections at 36 months was numerically higher (117 vs. 64) in the patients maintained on steroids.

Conclusion: When evaluating the composite endpoint, pancreas transplant recipients on a steroid-free regimen do not appear to be at increased risk of graft loss, patient death or rejection. Avoidance of long term prednisone may reduce the risk of infectious complications post-pancreas transplant.

CITATION INFORMATION: Cote M., Rogers C., Khwaja K., Evenson A., Pavlakis M., Richards K. Impact of a Steroid Free Immunosuppressive Regimen on Patient and Graft Outcomes in Pancreas Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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