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Beyond Borders: International Immunosuppression Practices in Pediatric Lung Transplantation
Erica Wong1, Jake Brockmeyer1, Christian Benden2,3
1Department of Pharmacy, Lucile Packard Children's Hospital, Stanford University, Palo Alto, California, USA.
Insights
Pediatric lung transplant immunosuppression shows global practice variation. Experts desire standardized, evidence-based guidelines due to insufficient current recommendations for children.
Area of Science:
- Pediatric transplantation
- Immunosuppression therapy
- Clinical practice guidelines
Background:
- Current lung transplant immunosuppression guidelines are not pediatric-specific.
- Pediatric immunosuppression often relies on adult-extrapolated data.
- Lack of tailored guidelines creates uncertainty in pediatric lung transplant care.
Purpose of the Study:
- To assess current immunosuppression practices in pediatric lung transplantation.
- To identify the need for evidence-based guidelines in pediatric lung transplant programs.
- To understand expert opinions on induction and maintenance immunosuppression protocols.
Main Methods:
- An anonymous survey was distributed to International Pediatric Lung Transplant Collaborative (IPLTC) members.
- Participants included pediatric lung transplant physicians and pharmacists.
- Survey covered induction/maintenance immunosuppression, drug monitoring, and guideline availability.
Main Results:
- Basiliximab was the preferred induction immunosuppression for 57% of respondents.
- Tacrolimus, mycophenolate mofetil, and corticosteroids were the preferred maintenance regimen (95.2%).
- 90% of respondents found existing guidelines insufficient for pediatric lung transplantation.
Conclusions:
- Significant variability exists in pediatric lung transplant immunosuppression protocols worldwide.
- There is a clear consensus on the lack of unified, evidence-based practice guidelines.
- Future research is needed to establish standardized pediatric lung transplant immunosuppression practices.
Introduction:
Current recommendations for lung transplantation immunosuppression do not explicitly target children, and many pharmacotherapies used in pediatrics are extrapolated from adults.
Methods:
Data were collected from an anonymous survey distributed to International Pediatric Lung Transplant Collaborative (IPLTC) members from November 2023 to February 2024. Eligible participants included pediatric lung transplant physicians, pharmacists, or others with expertise in their lung transplant center's protocols. Participant and program demographics were surveyed, including location and transplant volume. Seventeen multiple-choice questions, text responses, and Likert scale statements covered the following: induction immunosuppression, maintenance immunosuppression, drug monitoring, dose optimization, and expert guidance available in current literature.
Results:
Among the 23 pediatric lung transplant healthcare professionals who responded, 13 respondents (57%) preferred using basiliximab as their standard induction immunosuppression. 3 (13%) prefer rabbit anti-thymocyte globulin (rATG), while 7 (30%) consider either rATG or basiliximab for induction. Of 22 responses with 100% completion, 21 of 22 (95.2%) respondents reported a combination of tacrolimus, mycophenolate mofetil (MMF), and corticosteroids (CCS) as their preferred maintenance immunosuppression regimen, reflecting the suggested preferred regimen for pediatric lung transplantation. Feedback on the perception of available evidence-based or established guidelines revealed the majority (90.0%) of respondents found them to be insufficient for pediatrics.
Conclusion:
This international survey highlights the variability in immunosuppression practices across pediatric lung transplant programs around the world. The findings underscore a gap in unified, evidence-based practice guidelines. With strong consensus among respondents on the lack of established guidelines, there is a clear directive for future research to establish standardized practices in pediatric lung transplantation.
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