Volume 23, Issue 8 e13573
ORIGINAL ARTICLE

Analysis of rabbit anti-thymocyte globulin vs basiliximab induction in pediatric liver transplant recipients

David M. Newland

Corresponding Author

David M. Newland

Department of Pharmacy, Seattle Children's Hospital, Seattle, WA, USA

School of Pharmacy, University of Washington, Seattle, WA, USA

Correspondence

David M. Newland, Department of Pharmacy, Seattle Children's Hospital, Seattle, WA, USA.

Email: [email protected]

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Macy J. Royston

Macy J. Royston

Department of Pharmacy, Seattle Children's Hospital, Seattle, WA, USA

School of Pharmacy, University of Washington, Seattle, WA, USA

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Derry R. McDonald

Derry R. McDonald

Department of Pharmacy, Seattle Children's Hospital, Seattle, WA, USA

School of Pharmacy, University of Washington, Seattle, WA, USA

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Thomas L. Nemeth

Thomas L. Nemeth

Department of Pharmacy, Seattle Children's Hospital, Seattle, WA, USA

School of Pharmacy, University of Washington, Seattle, WA, USA

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Kelly Wallace-Boughter

Kelly Wallace-Boughter

Division of Transplantation, Department of Surgery, Seattle Children's Hospital, Seattle, WA, USA

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Kristen Carlin

Kristen Carlin

Children's Core for Biomedical Statistics, Seattle Children's Research Institute, Seattle, WA, USA

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Simon Horslen

Simon Horslen

Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA

Department of Gastroenterology, Hepatology and Nutrition, Seattle Children's Hospital, Seattle, WA, USA

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First published: 12 September 2019
Citations: 6

Data Availability Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abstract

Literature is limited comparing induction immunosuppression in pediatric liver transplant (LTx) recipients. This is a single-center, retrospective cohort study of primary pediatric liver transplants at our center between 2005 and 2016 who received either basiliximab (BSX) or rabbit anti-thymocyte globulin (rATG) induction. Maintenance immunosuppression consisted of tacrolimus ± a corticosteroid taper. Exclusions included receipt of an ABO-incompatible graft, retransplantation, and multi-organ transplantation. Primary outcomes were incidence of treated biopsy-proven acute rejection (tBPAR) and PTLD within the first year and infections within 90 days of LTx. Secondary outcomes included graft and patient survival, time to first tBPAR, and incidence of steroid-resistant rejection (SRR) within the first year post-LTx. A total of 136 patients were included in the final analysis of which 57 patients (42%) received BSX induction. Patients who received rATG induction with or without a 2-week corticosteroid taper experienced significantly more tBPAR compared to those who received BSX induction with a 6-month corticosteroid taper (55.7% vs 33.3%, P = .01). There were no differences in the incidence of PTLD, infections, SRR, graft or patient survival, or time to first tBPAR between the two groups. Induction with rATG either with or without a short corticosteroid taper was associated with significantly more tBPAR in primary pediatric LTx recipients when compared to BSX induction with a prolonged corticosteroid taper in the setting of maintenance immunosuppression with tacrolimus.

CONFLICT OF INTEREST

The authors of this manuscript have no conflicts of interest to disclose as described by Pediatric Transplantation.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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