Association Between Early Immunosuppression Center Variability and One-Year Outcomes After Pediatric Liver Transplant

Area of Science:

• Pediatric transplantation
• Immunosuppression protocols
• Graft survival

Background:

• Liver transplant (LT) centers exhibit variability in early immunosuppression practices, despite existing institutional protocols.
• This variability can impact patient outcomes.

Purpose of the Study:

• To measure within-center variability in early immunosuppression after pediatric liver transplant (LT).
• To examine the association between immunosuppression variability and one-year outcomes.

Main Methods:

• Analysis of pediatric LTs from 2013 to 2018 using the United Network for Organ Sharing registry.
• Categorization of induction regimens (corticosteroids, T-cell depleting antibody, non-T-cell depleting antibody).
• Assessment of coefficient of immunosuppression variability (CIV) in induction and mycophenolate mofetil (MMF) use, linked to one-year graft survival, patient survival, and acute rejection rates.

Main Results:

• The study included 2542 pediatric LT recipients from 67 centers.
• Higher induction CIV was significantly associated with increased odds of first-year acute rejection (OR 2.72).
• MMF CIV and neither induction nor MMF CIV were associated with one-year graft or patient survival.

Conclusions:

• Induction CIV is linked to higher odds of acute rejection within the first year post-transplant.
• Reducing immunosuppression variability may be a target for improving outcomes.
• Further research is needed to understand the drivers of high CIV.