832 Although corticosteroids are widely used as immunosuppressants (IS), there is ongoing controversary regarding their optimal use in pediatric solid organ transplantation. Purpose: To report a single center experience of pediatric heart transplant recipients without maintenance steroid IS. Data was obtained by review of all patients transplanted since 1988 over 4 years old at transplant. Patient age, survival, current medications, biopsy results, and details of all episodes of graft rejection were analyzed. There were 42 patients (26 males). Six were excluded from analysis (3 followed elsewhere, 3 perioperative deaths), leaving 36 patients who had 38 transplants. Median age at transplant (all 38 grafts) was 10.6 yrs (3.8-22.6yrs) with median follow up of 2.8 yrs (0.04-10.5yrs). Endomyocardial biopsies (EMB) were done by protocol at 1, 3 and 12 months post-transplant and yearly thereafter, or at the time of suspected rejection. All patients received 10 mg/kg × 6 doses of methylprenisolone as part of routine induction and then steroids were discontinued. Rejection was treated with bolus steroids alone (34%), steroids and anti-T cell antibodies (37%), steroids and methotrexate (14.5%), and increased basal IS without steroids (14.5%). Results: There were 190 EMB (5.0±2.4 per graft): 34 Grade 0, 42 - 1A, 62 - 1B, 9 - II, 16 - IIIA, 19 - IIIB, 2 - IV, 3 "no" and 3 "mild" rejection (prior to ISHLT grading). There were 103 episodes of acute rejection (2.7 per graft): 51 early (<3 months), and 52 late. Diagnosis was by clinical criteria and/or echo in 63% and by EMB in 37%. Median time to first rejection was 34 days (5 days-5.1 yrs). Four patients had no rejection. Only 3/36 (8.3%) patients received maintenance steroids for a prolonged period of time: 6 mo (deceased), 10 mo (discontinued), and 2 yrs (retransplanted). Graft coronary artery disease was present in 10/38 grafts (26%). Diagnosis was by angiography (4) and intravascular ultrasound (3) at a mean follow up in 7 grafts of 4.5 yrs (1.5-10.5 yrs). Remaining 3 were noted by pathology. Two patients (6%) were successfully retransplanted at 5 and 5.6 yrs. Two patients (6%) died due to rejection (9 mo, 4.5 yrs). Graft survival at 1 and 5 yrs was 97% and 92% with overall patient survival rates at 1 and 5 yrs of 97% and 94%. Current immunosuppression in the 34 survivors is CyA/Aza in 19, CyA/MMF in 6, and FK506/MMF in 9. Conclusion: Pediatric heart transplant recipients can be successfully managed without steroid IS without an increase in rate of rejection, graft failure, graft coronary artery disease, or mortality.