The Effect of Steroid Maintenance in Recipients with Pancreas Transplant Alone

Abstract

Background In solid organ transplantation, the use of steroids for maintenance therapy is common. However, the appropriateness of steroid maintenance or withdrawal in pancreas transplantation is unproven, especially in recipients with pancreas transplant alone. Therefore, we aimed to assess the effect of steroid treatment in pancreas transplant alone. Methods From January 2004 to December 2016, we performed 101 pancreas transplant alone. Among them, 12 (11.9%) recipients maintained the steroid and 89(88.1%) recipients withdraw steroid early. We compared their clinical characteristics and graft outcomes. Results Demographics of recipients in both group was not significantly different, except retransplant(p=0.006). The cause of steroid maintenance is clinical rejection(n=3), past tuberculosis history(n=2), low eGFR at the time of transplantation (n=2), Hepatitis B virus carrier(n=2), preoperative DSA positive (n=1), and 2nd PTA(n=1). In early periods, fever development(including non-infectious and infectious cause) is more common in steroid withdrawal(62.1% vs. 33.3%, p=0.058). During the follow-up periods, graft rejection rate after discharge was not significantly different between steroid withdrawal and maintenance (9.0% vs. 25%, p=0.095). Rejection free graft survival and overall graft survival between two group were not significantly different (p=0.081 and 0.095, respectively). There were no significant difference in infection rate such as UTI, pneumonia, CMV, aspergillosis, candidiasis, and tuberculosis. However, influenza and herpes zoster infection were significantly higher in steroid maintenance group(6.5% vs. 25%, p=0.037, and 8.0% vs. 33.3%, p=0.008). Conclusion In our center, we couldn’t find out that steroid withdrawal increase infection rate significantly. And steroid maintenance didn’t show any advantage in graft rejection and graft outcomes. Therefore, steroid withdrawal may be safe in PTA recipients.