Division of Gastroenterology, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Am J Transplant. 2023 Jun;23(6):794-804. doi: 10.1016/j.ajt.2023.03.008. Epub 2023 Mar 17.
Data on the potential benefits and risks of induction therapy in pediatric liver transplantation (LT) are limited. This was a retrospective cohort study of 2748 pediatric LT recipients at 26 children's hospitals between January 1, 2006 to May 31, 2017 using data from the pediatric health information system linked to the United Network for Organ Sharing database. The induction regimen was obtained from the pediatric health information system day-by-day pharmacy resource utilization. Cox proportional hazards evaluated the association of induction regimen (none/corticosteroid-only, nondepleting, and depleting) on patient and graft survival. Additional outcomes, including opportunistic infections and posttransplant lymphoproliferative disorder, were studied using multivariable logistic regression. Overall, 64.9% received none/corticosteroid-only induction, whereas 28.1% received nondepleting, 8.3% received depleting, and 2.5% other antibody regimens. Differences in patient characteristics were small, but center practices were heterogeneous. Compared with none/corticosteroid-only induction, nondepleting induction was associated with reduced acute rejection (odd ratio [OR], 0.53; P <.001) but with the increased posttransplant lymphoproliferative disorder (OR, 1.75; P =.021). Depleting induction was associated with improved graft survival (hazard ratio [HR], 0.64; P =.028) but with increased noncytomegalovirus opportunistic infections (OR, 1.46; P =.046). Depleting induction is underused yet may offer long-term benefits in this large multicenter cohort. Greater consensus guidance in this aspect of pediatric LT care is warranted.
关于诱导治疗在儿科肝移植（LT）中的潜在益处和风险的数据有限。这是一项回顾性队列研究，纳入了 2006 年 1 月 1 日至 2017 年 5 月 31 日期间在 26 家儿童医院接受 LT 的 2748 名儿科患者，该研究数据来源于与美国器官共享网络数据库相关联的儿科健康信息系统。诱导方案通过儿科健康信息系统每天的药房资源利用情况获得。Cox 比例风险评估了诱导方案（无/仅皮质类固醇、非消耗性和消耗性）对患者和移植物存活率的影响。使用多变量逻辑回归研究了其他结局，包括机会性感染和移植后淋巴增殖性疾病。总体而言，64.9%的患者接受了无/仅皮质类固醇诱导，28.1%的患者接受了非消耗性诱导，8.3%的患者接受了消耗性诱导，2.5%的患者接受了其他抗体方案。患者特征的差异较小，但中心实践存在异质性。与无/仅皮质类固醇诱导相比，非消耗性诱导与急性排斥反应减少相关（比值比 [OR]，0.53；P<0.001），但与移植后淋巴增殖性疾病增加相关（OR，1.75；P=0.021）。消耗性诱导与移植物存活率改善相关（风险比 [HR]，0.64；P=0.028），但与非巨细胞病毒机会性感染增加相关（OR，1.46；P=0.046）。消耗性诱导的应用不足，但在这个大型多中心队列中可能具有长期获益。在儿科 LT 护理的这一方面，需要更多的共识指导。
