Lack of differences in safety and effectivity among three induction immunosuppression protocols during the first-year post-liver transplantation in pediatric patients. A multicenter study

COSTAGUTA A; COSTAGUTA G; D´AGOSTINO D; GONDOLESI G; PALLITTO MB; RUMBO C; BOTTASSO O; ALVAREZ F

Viena

Congreso; 55th Annual Meeting of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN); 2023

European Society of Pediatric Gastroenterology, Hepatology and Nutrition

Objectives and Study: Immunosuppression practice varies among centers. Very few comparativestudies are published to define the best approach on an evidence-based background. Pediatric patients are ideal to explore potential differences due to fewer comorbidities, and being a more homogeneous population.Methods: A retrospective, observational study of all first liver transplants in the four participating centers between january 2015 and december 2019 was conducted. Based on the immunosuppression administered during the immediate posttransplant setting, patients were classified as Group A (Basiliximab + Steroids + Tacrolimus), B (same as A + Thymoglobulin), and C (Steroids + Tacrolimus). Patients with other schemes were excluded. Main variables were incidence of rejection, CMV/EBV or other infections, and first-year patient and graft survivals. A sub-set analysis on Biliary Atresia patients was also carried out to assess a more homogeneous population. A p-value< 0.05 was considered significant.Results: 97 patients from 4 centers were recruited (Group A n= 52, Group B n= 25, Group C n= 20).Proportion of living donors were similar among groups (p=0.93). There were no differences in frequency of rejection (p=0.12), active CMV (p=0.10) or EBV (p=0.12) replication or development of other viral or bacterial infections (p=0.96) among groups, as were for patient (p=0.12) or graft (p=0.30) survival.Considering the 48 patients with Biliary Atresia (Group A n=26, Group B n=16, Group C n=6), frequency of rejection (p=0.64), EBV replication (p=0.92), and other infections (p=0.30) were similar; only CMV replication was more frequent in group B if compared to Group C (p=0.04). First year patient (p=0.61) and graft survival (100% in all groups) were similar as well.Conclusions: Results during the first-year post-liver transplantation are comparable regardless of the immunosuppression protocol employed, either in the whole group or in those with Biliary Atresia. Since our study has been retrospective, a multicenter prospective study would be required to validate this conclusion.