https://pubmed.ncbi.nlm.nih.gov/36933831/ Transplant
Am J Transplant. 2023 Mar 16;S1600-6135(23)00351-9.
doi: 10.1016/j.ajt.2023.03.008.Online ahead of print.

The Effectiveness and Safety of Antibody Induction Immunosuppression in a Large Cohort of U.S. Pediatric Liver Transplant Recipients

Phoebe Wood 1, Yuan-Shung Huang 2, Lucia Sanchez 3, Eimear Kitt 4, Peter L Abt 5, Therese Bittermann 6

Abstract
Data on the potential benefits and risks of induction therapy in pediatric liver transplantation (LT) are limited. This was a retrospective cohort study of 2,748 pediatric LT recipients at 26 children's hospitals between 1/1/2006-5/31/2017 using data from the Pediatric Health Information System (PHIS) linked to the United Network for Organ Sharing database. Induction regimen was obtained from PHIS day-by-day pharmacy resource utilization. Cox proportional hazards evaluated the association of induction regimen (none/corticosteroid-only, non-depleting, depleting) on patient and graft survival. Additional outcomes, including opportunistic infections (OI) and post-transplant lymphoproliferative disorder (PTLD) were studied using multivariable logistic regression. Overall, 64.9% received none/corticosteroid-only induction, while 28.1% received non-depleting, 8.3% received depleting and 2.5% other antibody regimens. Differences in patient characteristics were small, but center practices were heterogeneous. Compared to none/corticosteroid-only induction, non-depleting induction was associated with reduced acute rejection (OR 0.53; p<0.001), but with increased PTLD (OR 1.75; p=0.021). Depleting induction was associated with improved graft survival (HR 0.64; p=0.028), but with increased non-cytomegalovirus OIs (OR 1.46; p=0.046). 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.