Background: Steroid based maintenance Immunosuppression (IS) regimen is the standard protocol for many kidney transplant(tx) centers. However, concerns for chronic steroid impact on patients remains including risk for post-tx diabetes and osteoporosis. Since 2003, Indiana University has adopted a steroid free IS regimen and hereby presents patient's outcomes over a ten-year period.

Methods: A retrospective chart review of patients who received a kidney tx between Jan 1, 2005 and June 31, 2015 with minimal 1 yr follow up. Patients with multi organ tx were excluded. Patients received anti- thymocyte antibodies with pulse steroid induction (Early five days withdraw) except zero mismatches who received basiliximab. Patients were placed on steroid free two drugs maintenance IS regimen .Clinical outcomes were compared to 2014 Scientific Registry of Transplant Recipient (SRTR) report on kidney tx recipients with 70% of patients on steroid based IS regimen.

Results: 2135 kidney tx recipients were included over a 10.5 years' period. Mean follow up time was 4.6 +/- 2.8 years with median follow up of 4 years .There were 857 (40.2%) living donor(LD) recipients' vs 1278(59.8%) deceased donor(DD) recipients. 157 patients (7.3%) had positive flow cytometry crossmatch and received desensitization therapy. 324 (15.1%) recipients were repeat kidney transplants. Overall 1 yr rejection rate was 17%. Total kidney allograft loss including graft loss due to death was 23% and patient's mortality over study period was 17%. While there was no significant difference in the 1yr rejection rate between LD and DD recipients (16% vs 21.4%, p=0.306), graft loss and patient's death over study period was however significantly lower in LD tx recipients (19.7% vs 25.4 %( p=0.002) and 8.8% vs 16.7% p=0.0002 respectively). 2014 SRTR reports 1 Yr acute rejection rate as ~10% while the 5-yr all-cause graft failure rates were 26.5% for DDtx and 14.3% for LD tx.Steroid free maintenance Immunosuppression regimen is comparable to steroid based regimen without increase risk for graft loss in the intermediate term.

CITATION INFORMATION: Hussain S, Taber T, Sharfuddin A, Yaqub M, Goggins W, Mishler D, Adebiyi O. Steroid Free Maintenance Immunosupression in Kidney Transplantation: Indiana University Experience. Am J Transplant. 2017;17 (suppl 3).

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