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Variation in immunosuppression practices among pediatric liver transplant centers—Society of Pediatric Liver Transplantation survey results
Author(s) -
Slowik Voytek,
Lerret Stacee M.,
Lobritto Steven J.,
Voulgarelis Stylianos,
Vitola Bernadette E.
Publication year - 2021
Publication title -
pediatric transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.457
H-Index - 69
eISSN - 1399-3046
pISSN - 1397-3142
DOI - 10.1111/petr.13873
Subject(s) - medicine , liver transplantation , tacrolimus , thymoglobulin , immunosuppression , transplantation , intensive care medicine , pediatrics
Background Variation in IS exists among pediatric liver transplant centers. While individual centers may publish their practice paradigms, current data on practices as a whole are lacking. This study sought to ascertain the IS protocols of pediatric liver transplant centers within the SPLIT to better understand variability and similarities among peer institutions. Methods A 27‐item questionnaire was developed within the SPLIT Quality Improvement and Clinical Care Committee. The survey collected data regarding center demographics, IS practices, and treatment of acute cellular rejection. Results Twenty‐eight (64%) SPLIT centers responded with 22 (79%) centers performing more than 10 transplants per year and 17 (61%) following more than 100 post‐transplant recipients. All centers use a written protocol, and 25 (89%) have a dedicated transplant pharmacist/PharmD. Twenty‐five (89%) centers use steroids for induction alone or in combination with thymoglobulin/interleukin‐2 antibodies. All centers use tacrolimus for initial maintenance therapy. Most centers have specialized protocols for ABO‐incompatible transplants, recipients with renal dysfunction, autoimmune liver diseases, and liver tumors. Treatment of rejection varied but was associated with escalation in IS. Conclusion IS practices among pediatric liver transplant centers are similar including the use of written protocols, pharmacy involvement, steroids for induction, tacrolimus as initial IS, tacrolimus reduction/delay for renal dysfunction, and escalation of IS with rejection severity. However, other IS practices show wide variability including treatment for ABO‐incompatible grafts and presumed rejection. This study serves as a foundation to guide prospective research linking IS practice to outcomes to determine best practice.