Variation in immunosuppression practices among pediatric liver transplant centers-Society of Pediatric Liver Transplantation survey results. Pediatr Transplant 2021 Mar;25(2):e13873
Date
10/08/2020Pubmed ID
33026158DOI
10.1111/petr.13873Scopus ID
2-s2.0-85092142965 (requires institutional sign-in at Scopus site) 10 CitationsAbstract
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.
Author List
Slowik V, Lerret SM, Lobritto SJ, Voulgarelis S, Vitola BEAuthors
Stacee Lerret PhD Professor Hybrid in the Pediatrics department at Medical College of WisconsinBernadette Vitola MD, MPH Associate Professor in the Pediatrics department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdolescentChild
Child, Preschool
Cross-Sectional Studies
Drug Therapy, Combination
Graft Rejection
Health Care Surveys
Healthcare Disparities
Humans
Immunosuppressive Agents
Induction Chemotherapy
Infant
Infant, Newborn
Liver Transplantation
Maintenance Chemotherapy
Practice Patterns, Physicians'
Quality Improvement
Societies, Medical
United States
