Steroid maintenance is associated with an increased risk of infections but has no effect on patient and graft survival in pancreas transplantation: A retrospective review of the UNOS database.
BACKGROUND
The appropriateness of steroid maintenance in pancreas transplantation is unproven. The current literature is insufficient due to small numbers, short follow-up and sparse data.


METHODS
Data from the UNOS database on adults ≥18 years old, who received pancreas and kidney-pancreas transplants between January 1996 and March 2014 were analyzed (n = 27,077). Two groups were evaluated: (a) Steroids Induction only (n = 4391) and (b) Steroid maintenance (n = 22,686). One-, 3-, 5-, 10-, and 15-year unadjusted patient and graft survival rates were compared. A Cox proportional hazards model was used to determine what patient factors were associated with these outcomes.


RESULTS
There were differences in patient survival at 1 and 3 years and in graft survival at 3 and 5 years. There was a higher rate of infectious complications in the maintenance group, but after controlling for several recipient factors, whether a patient received steroid maintenance or not, was not significantly associated with the risk of death or graft failure.


CONCLUSIONS
The use of maintenance steroids is significantly associated with an increased risk of infectious complications, but no difference in patient death or graft failure after controlling for multiple recipient factors. There is also no benefit with the use of steroid maintenance after pancreas transplantation.
Center for Diseases of the Pancreas, Department of General Surgery, North Shore Long Island Jewish Health System-Hofstra University School of Medicine, Manhasset, NY, USA. Electronic address: amodleo@gmail.com.
Leo I
LI
Amodu
Center for Diseases of the Pancreas, Department of General Surgery, North Shore Long Island Jewish Health System-Hofstra University School of Medicine, Manhasset, NY, USA.
Mukesh
M
Tiwari
Center for Diseases of the Pancreas, Department of General Surgery, North Shore Long Island Jewish Health System-Hofstra University School of Medicine, Manhasset, NY, USA.
Asaph
A
Levy
Department of Biostatistics, Feinstein Institute for Medical Research, Manhasset, NY, USA.
Meredith
M
Akerman
Center for Diseases of the Pancreas, Department of General Surgery, North Shore Long Island Jewish Health System-Hofstra University School of Medicine, Manhasset, NY, USA.
Sameer
S
Rehman
Center for Diseases of the Pancreas, Department of General Surgery, North Shore Long Island Jewish Health System-Hofstra University School of Medicine, Manhasset, NY, USA.
Adam
A
Kressel
Center for Diseases of the Pancreas, Department of General Surgery, North Shore Long Island Jewish Health System-Hofstra University School of Medicine, Manhasset, NY, USA.
Horacio
H
Rilo
Center for Diseases of the Pancreas, Department of General Surgery, North Shore Long Island Jewish Health System-Hofstra University School of Medicine, Manhasset, NY, USA.
Ernesto
E
Molmenti
Department of Surgical Transplantation, University of Toledo Medical Center, Toledo, OH, USA.
Jorge
J
Ortiz
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D007239:Infections / Q000276:immunology*; D060046:Maintenance Chemotherapy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000401:mortality; D011183:Postoperative Complications / Q000276:immunology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013256:Steroids / Q000009:adverse effects* / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
D007166:Immunosuppressive Agents; D013256:Steroids
Graft; Immunosuppression; Induction; Maintenance; Outcome; Steroids