Impact of early immunosuppression on pediatric liver transplant outcomes within 1 year.
Impact of early immunosuppression on pediatric liver transplant outcomes within 1 year.
复制标题
早期免疫抑制对一年内儿童肝移植结果的影响。
DOI：
10.1002/jpn3.12112
复制
发表时间：
2024
影响因子：
2.9
通讯作者：
Perito,EmilyR
中科院分区：
文献类型：
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作者：
Raghu,VikramK;Zhang,Xingyu;Squires,JamesE;Eisenberg,Elizabeth;Feldman,AmyG;Halma,Jennifer;Peters,AnnaL;Gonzalez-Peralta,ReginoP;Ng,VickyL;Horslen,SimonP;Lobritto,StevenJ;Bucuvalas,John;Mazariegos,GeorgeV;Perito,EmilyR
Starzl小儿移植卓越网络将优化免疫抑制（IS）确定为患者、家属和提供者的优先实践改进领域。我们的目的是评估临床特征，早期IS，和outcomes.MethodsWe之间的关联分析儿科肝移植（LT）数据从2013年至2018年在器官共享联合网络（UNOS）和儿科肝移植协会（SPLIT）registrations.ResultsWe包括2542 LT收件人在UNOS和1590在SPLIT。不同中心的IS选择不同，类固醇诱导和霉酚酸酯（MMF）的使用率各为0%至100%。与早期IS选择相关的临床特征在两个数据集之间不一致。T细胞消耗抗体的使用与1年移植物改善相关（风险比[HR] 0.50，95%置信区间[CI] 0.34 - 0.76）和患者（HR 0.40，95% CI 0.20−0.79）UNOS的生存率，但1年患者生存率降低（HR 4.12，95% CI 1.31 - 12.93）和SPLIT中急性排斥反应增加（HR 1.58，95% CI 1.07 - 2.34）。使用非T细胞耗竭抗体与生存或排斥的不同风险无关。在UNOS中，使用MMF与1年移植物存活率改善相关（HR 0.73，95%CI 0.54 - 0.99）。UNOS和SPLIT数据在多变量分析中提供了IS和结局之间的相互矛盾的关联。这些结果强调了未来多中心合作工作的必要性，以确定基于证据的IS最佳实践。
ObjectivesThe Starzl Network for Excellence in Pediatric Transplantation identified optimizing immunosuppression (IS) as a priority practice improvement area for patients, families, and providers. We aimed to evaluate associations between clinical characteristics, early IS, and outcomes.MethodsWe analyzed pediatric liver transplant (LT) data from 2013 to 2018 in the United Network for Organ Sharing (UNOS) and the Society of Pediatric Liver Transplantation (SPLIT) registries.ResultsWe included 2542 LT recipients in UNOS and 1590 in SPLIT. IS choice varied between centers with steroid induction and mycophenolate mofetil (MMF) use each ranging from 0% to 100% across centers. Clinical characteristics associated with early IS choice were inconsistent between the two data sets. T‐cell depleting antibody use was associated with improved 1‐year graft (hazard ratio [HR] 0.50, 95% confidence interval [CI] 0.34−0.76) and patient (HR 0.40, 95% CI 0.20−0.79) survival in UNOS but decreased 1‐year patient survival (HR 4.12, 95% CI 1.31−12.93) and increased acute rejection (HR 1.58, 95% CI 1.07−2.34) in SPLIT. Non‐T‐cell depleting antibody use was not associated with differential risk of survival nor rejection. MMF use was associated with improved 1‐year graft survival (HR 0.73, 95% CI 0.54−0.99) in UNOS only.ConclusionsVariation exists in center choice of early IS regimen. UNOS and SPLIT data provide conflicting associations between IS and outcomes in multivariable analysis. These results highlight the need for future multicenter collaborative work to identify evidence‐based IS best practices.