Artículo
Feasibility of steroid-free tacrolimus-basiliximab immunosuppression in pediatric liver transplantation and predictors for steroid requirement
Trezeguet Renatti, Guido
; Riva, Natalia
; Minetto, Julia; Reijenstein, Hayellen; Gole, Maria; Meza, Verónica; Bosaleh, Andrea; Licciardone, Nieves; Aredes, Diego Eduardo; Lauferman, Leandro; Schaiquevich, Paula Susana
; Cervio, Guillermo; Dip, Marcelo Fabian; Schaiquevich, Paula Susana
; Halac, Esteban Tomas; Imventarza, Oscar Cesar
Fecha de publicación:
01/2024
Editorial:
Wolters Kluwer Medknow Publications
Revista:
Liver Transplantation
e-ISSN:
1527-6473
Idioma:
Inglés
Tipo de recurso:
Artículo publicado
Clasificación temática:
Resumen
Avoidance of steroids in pediatric liver transplantation may reduce toxicity and morbidity. The aim of this study was to analyze the feasibility of a steroid-free tacrolimus-basiliximab immunosuppression scheme, the risk factors associated with steroid requirement, and safety parameters. Patients who underwent liver transplantation for biliary atresia between 2011 and 2019 were included and followed for 6 months after transplantation. Immunosuppression consisted of tacrolimus-based treatment with basiliximab induction. Steroid-free survival was estimated, and risk factors for steroid requirement were evaluated using multivariate Cox regression analysis. A total of 76 patients were included, of whom 42 (55.3%) required steroids (>14 d) due to biopsy-proven acute rejection (47.6%, n = 20), instability in liver function tests (35.7%, n = 15), tacrolimus-related adverse drug reactions (14.3%, n = 6), or other reasons (bronchospasm episode, n = 1). Steroid-free survival was 45.9% (95% CI, 35.9-58.8). Independent factors associated with steroid requirement included tortuosity in tacrolimus trough levels (≥1.76 vs. <1.76: HR 5.8, 95% CI, 2.6-12.7; p < 0.001) and mean tacrolimus trough levels (≥ 6.4 ng/mL vs. < 6.4 ng/mL: HR 0.4, 95% CI, 0.2-0.7; p = 0.002). The rate of bacterial and viral infections was comparable between patients with and without steroids, although in the former group, cytomegalovirus infection developed earlier ( p = 0.03). Patients receiving steroids had higher total cholesterol, LDL, and HDL levels ( p < 0.05) during follow-up, but no changes in the height Z-score were observed 1 year after transplantation. Basiliximab induction in combination with tacrolimus-based treatment avoided steroid requirements in 45% of the patients. Tacrolimus variability and trough levels below 6.4 ng/mL independently increased the risk of steroid requirement. Further efforts should be focused on personalizing immunosuppressive treatment.
Palabras clave:
TRANSPLANT
,
PEDIATRIC
,
LIVER
,
REJECTION
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Licencia
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Colecciones
Articulos(SEDE CENTRAL)
Articulos de SEDE CENTRAL
Articulos de SEDE CENTRAL
Citación
Trezeguet Renatti, Guido; Riva, Natalia; Minetto, Julia; Reijenstein, Hayellen; Gole, Maria; et al.; Feasibility of steroid-free tacrolimus-basiliximab immunosuppression in pediatric liver transplantation and predictors for steroid requirement; Wolters Kluwer Medknow Publications; Liver Transplantation; 30; 1; 1-2024; 61-71
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