Introduction: Previous studies consistently demonstrate worse outcomes for African American (AA) pediatric heart transplant (HT) recipients when compared to non-AA counterparts. Medical and social factors have been implicated in this discrepancy. As such, chronic corticosteroid use as maintenance immunosuppression for AA HT patients may be beneficial, though this has not been studied. Hypothesis: Chronic maintenance corticosteroid therapy does not decrease rejection or graft failure in AA pediatric HT recipients. Methods: We performed a retrospective analysis of the Pediatric Heart Transplant Society (PHTS) database for all HT recipients <18 y.o. from January 1 st , 2007 to June 30 th , 2021. Retransplants and multiorgan transplants were excluded. Chronic steroid use was defined as taking oral steroids at one-year post-HT in the absence of rejection past 60 days post-HT to exclude patients who were on steroids for-cause. We used Kaplan-Meier and log-rank analyses for outcome comparisons among cohorts after the first year post-HT. Results: A total of 4099 patients were included, of which 780 (19%) were AA. Of the cohort, 756 (18.4%) were on chronic steroids. Within that group, 157 (20.1%) were AA. Patients on chronic steroids at individual centers ranged 0%-64.7% (median 11.5%, SD 16.9%), with no collective difference between steroid use in AA and non-AA patients. Freedom from rejection was worse in AA compared to non-AA patients, both in steroid and no steroid groups (p<0.01). In the non-AA cohort, freedom from rejection was better in the no steroid group (p<0.01). In the AA cohort, there was no statistical difference in rejection between the steroid and no steroid groups (p=0.20). Analyses of graft survival resulted in the same pattern. Conclusion: Use of Chronic steroids varies widely across pediatric HT centers, with no difference between AA and non-AA patients. AA patients have worse rejection and graft failure, and chronic steroid use did not affect these outcomes.