Session Time: 3:15pm-4:45pm
Presentation Time: 3:51pm-4:03pm
*Purpose: Induction immunosuppression for pediatric liver transplants varies widely among centers. We sought to evaluate the impact of different induction regimens on patient and graft survival.
*Methods: SRTR database was used to identify all pediatric primary liver transplant recipients between 2002-2016 who were discharged on tacrolimus, or tacrolimus and mycophenolate maintenance with or without steroids. Patients were grouped by type of induction into no induction, depletional, and non-depletional (IL-2) groups. Mixed effects proportional hazards and logistic regression models were fit to assess the association of induction therapy on graft and patient survival, and acute rejection in the first 6 and 12 months after adjusting for recipient and donor characteristics. Transplant center was included as a random effect in these models.
*Results: 5194 recipients met inclusion criteria, 473 received depletional induction, 968 received IL-2 inhibitors and 3753 received no induction. Patients receiving depletional (aHR:0.59, 95% CI:0.39-0.91) and IL-2 (aHR:0.88, 95% CI:0.45-1.72) had higher patient survival compared to those receiving no induction therapy (Figure 1). There were no significant differences in graft survival between the groups (p=0.13). Those receiving IL-2 were less likely to have an acute rejection episode within the first 12 months post-transplant compared to those receiving no induction (aOR: 0.74, 95% CI: 0.61-0.91, p=0.004), but there was no difference in acute rejection between those receiving depletional and no induction (aOR:1.15, 95% CI:0.89-1.48) (Table 1). There was no difference in the cause-specific hazard of death due to infection (p=0.63) among the groups.
*Conclusions: In this large cohort of pediatric primary liver transplant recipients, use of depletional induction was associated with higher patient survival. Use of IL-2 inhibitors was associated with lower rejection rates within 12 months. Our findings suggest that a biologic induction may be beneficial in primary pediatric liver transplant recipients.
To cite this abstract in AMA style:Shaker T, Ramanathan K, Riad S, Vock D, Chinnakotla S. Induction Immunosuppression in Primary Pediatric Liver Transplant Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/induction-immunosuppression-in-primary-pediatric-liver-transplant-recipients/. Accessed November 25, 2020.
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