{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T07:49:24Z","timestamp":1767340164261,"version":"3.41.2"},"reference-count":27,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2020,8,2]],"date-time":"2020-08-02T00:00:00Z","timestamp":1596326400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"publisher","award":["K23DK115908","K24DK101828"],"award-info":[{"award-number":["K23DK115908","K24DK101828"]}],"id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>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\u2010kidney (SLK) transplantation remains unclear, but small single\u2010center reports have shown success with steroid\u2010sparing regimens. We studied 4184 adult SLK recipients using the Scientific Registry of Transplant Recipients, from March 1, 2002, to February 28, 2017, on tacrolimus\u2010based regimens at 1\u00a0year post\u2010transplant. We determined the association between mIS regimen and mortality and graft failure using Cox proportional hazard models. The use of steroid\u2010sparing regimens increased post\u2010transplant, from 16.1% at discharge to 88.0% at 5\u00a0years. Using multi\u2010level logistic regression modeling, we found center\u2010level variation to be the major contributor to choice of mIS regimen (ICC 44.5%; 95% CI: 36.2%\u201053.0%). In multivariate analysis, use of a steroid\u2010sparing regimen at 1\u00a0year was associated with a 21% decreased risk of mortality compared to steroid\u2010containing regimens (aHR 0.79, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.01) and 20% decreased risk of liver graft failure (aHR 0.80, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.01), without differences in kidney graft loss risk (aHR 0.92, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.6). Among SLK recipients, the use of a steroid\u2010sparing regimen appears to be safe and effective without adverse effects on patient or graft survival.<\/jats:p>","DOI":"10.1111\/ctr.14036","type":"journal-article","created":{"date-parts":[[2020,7,11]],"date-time":"2020-07-11T21:39:14Z","timestamp":1594503554000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Steroid\u2010sparing maintenance immunosuppression is safe and effective after simultaneous liver\u2010kidney transplantation"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9952-9136","authenticated-orcid":false,"given":"Sharon R.","family":"Weeks","sequence":"first","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0244-9832","authenticated-orcid":false,"given":"Xun","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lindsey","family":"Toman","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmet O.","family":"Gurakar","sequence":"additional","affiliation":[{"name":"Department of Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fizza F.","family":"Naqvi","sequence":"additional","affiliation":[{"name":"Department of Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saleh A.","family":"Alqahtani","sequence":"additional","affiliation":[{"name":"Department of Medicine Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Philosophe","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew M.","family":"Cameron","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niraj M.","family":"Desai","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shane E.","family":"Ottmann","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorry L.","family":"Segev","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA"},{"name":"Department of Epidemiology Johns Hopkins School of Public Health Baltimore Maryland USA"},{"name":"Scientific Registry of Transplant Recipients Minneapolis Minnesota USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline","family":"Garonzik\u2010Wang","sequence":"additional","affiliation":[{"name":"Department of Surgery Johns Hopkins University School of Medicine Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,8,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14559"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/223472a0"},{"issue":"6","key":"e_1_2_7_4_1","first-page":"3315","article-title":"Frequent achievement of a drug\u2010free state after orthotopic liver transplantation","volume":"25","author":"Reyes J","year":"1993","journal-title":"Transplant 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