Steroid-sparing maintenance immunosuppression is safe and effective after simultaneous liver-kidney transplantation

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Optimization of maintenance immunosuppression (mIS) regimens in the transplant recipient requires a balance between sufficient potency to prevent rejection and avoidance of excessive immunosuppression to prevent toxicities and complications. The optimal regimen after simultaneous liver-kidney (SLK) transplantation remains unclear, but small single-center reports have shown success with steroid-sparing regimens. We studied 4184 adult SLK recipients using the Scientific Registry of Transplant Recipients, from March 1, 2002, to February 28, 2017, on tacrolimus-based regimens at 1 year post-transplant. We determined the association between mIS regimen and mortality and graft failure using Cox proportional hazard models. The use of steroid-sparing regimens increased post-transplant, from 16.1% at discharge to 88.0% at 5 years. Using multi-level logistic regression modeling, we found center-level variation to be the major contributor to choice of mIS regimen (ICC 44.5%; 95% CI: 36.2%-53.0%). In multivariate analysis, use of a steroid-sparing regimen at 1 year was associated with a 21% decreased risk of mortality compared to steroid-containing regimens (aHR 0.79, P =.01) and 20% decreased risk of liver graft failure (aHR 0.80, P =.01), without differences in kidney graft loss risk (aHR 0.92, P =.6). Among SLK recipients, the use of a steroid-sparing regimen appears to be safe and effective without adverse effects on patient or graft survival.

Original languageEnglish (US)
Article numbere14036
JournalClinical Transplantation
Issue number10
StatePublished - Oct 1 2020
Externally publishedYes


  • immunosuppressant
  • kidney (allograft) function
  • liver (allograft) function
  • scientific registry for transplant recipients

ASJC Scopus subject areas

  • Transplantation


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