{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T20:01:08Z","timestamp":1793995268974,"version":"4.8.0"},"reference-count":20,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Simultaneous pancreas and kidney (SPK) transplants using steroid\u2010free regimens are a frequently used immunosuppressive strategy in low immunologic risk recipients. The long\u2010term effect on recipient outcomes remains incompletely understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed post\u2010transplant outcomes in 307 SPK recipients from a single center, comparing early steroid withdrawal (after completion of Thymoglobulin) with maintenance steroids. Steroid withdrawal was primarily utilized in low immunologic risk patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In total, 170 SPK recipients underwent steroid withdrawal, and 137 received maintenance steroids. The withdrawal group had a lower cPRA and included fewer Black recipients. Biopsy\u2010proven rejection rates (kidney, pancreas, or both) were similar between groups (26% vs. 29%,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.523), with worse kidney\/pancreas graft survival among those with rejection. Rejection occurred earliest in recipients rejecting both the kidney and pancreas, followed by those rejecting the kidney alone, and then those rejecting the pancreas. Multivariate analysis showed that kidney and pancreas survival were strongly interdependent. Kidney rejection was the primary predictor of graft survival. The steroid regimen was not independently associated with survival of either organ. Obesity at follow\u2010up was associated with an increased risk of pancreas graft failure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this single\u2010center cohort, steroid withdrawal was safe in appropriately selected SPK recipients, with rejection\u2014not the steroid regimen\u2014driving long\u2010term graft outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70358","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T14:56:43Z","timestamp":1761317803000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Steroid Withdrawal Versus Maintenance in Simultaneous Pancreas\u2013Kidney Transplantation: Long\u2010Term Outcomes in a Single\u2010Center Retrospective Cohort"],"prefix":"10.1111","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9050-0436","authenticated-orcid":false,"given":"Raphael P. H.","family":"Meier","sequence":"first","affiliation":[{"name":"Division of Transplant Surgery Department of Surgery University of California San Francisco  San Francisco California USA"},{"name":"Division of Transplant Surgery Department of Surgery University of Maryland School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1039-2832","authenticated-orcid":false,"given":"Ali B.","family":"Abbasi","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery Department of Surgery University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerardo","family":"Gamino","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery Department of Surgery University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne M.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery Department of Surgery University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehdi","family":"Tavakol","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery Department of Surgery University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Conti","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery Department of Surgery University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minnie","family":"Sarwal","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery Department of Surgery University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G.","family":"Stock","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery Department of Surgery University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris E.","family":"Freise","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery Department of Surgery University of California San Francisco  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000439412"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000006415"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-199902270-00017"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200007273430401"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.138.10.1121"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0041-1345(00)02632-4"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfl660"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2009.02996.x"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2008.02212.x"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2011.03670.x"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2023.10.011"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007890-200001270-00012"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2005.00885.x"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399-0012.2000.140114.x"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2005.00816.x"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.tp.0000228904.01482.88"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.15063"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/TXD.0000000000001053"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/TXD.0000000000001720"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2032183"}],"container-title":["Clinical 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