Corticosteroid-Free Immunosuppression in Pediatric Liver Transplantation: Safety and Efficacy After a Short-Term Follow-up

D. Cintorino, S. Riva, M. Spada, M. Minervini, A. Sonzogni, C. Scotti Foglieni, S. Gruttadauria, R. Verzaro, K. Henderson, M. Aricò, B. Gridelli

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Abstract

Background: We report our results with the use of corticosteroid-free immunosuppression after pediatric liver transplantation, evaluating the efficiency and safety of this protocol in the early posttransplantation period. Patients and Methods: From July 2003 to October 2005, 34 liver transplantations were performed in 32 pediatric patients (19 boys, 13 girls) at our institution. Recipient median age was 5 years (range, 0.2-14 years), and median body weight was 10 kg (range, 4-49 kg). Twenty-seven patients received a graft from in situ split liver transplantation, 5 a whole graft. Twenty-nine children (90%) received an immunosuppressive therapy based on methylprednisolone IV bolus at reperfusion (10 mg/kg) plus tacrolimus given at an initial dose of 0.08 mg/kg/d and then adjusted to obtain whole blood trough levels of 10 to 15 ng/mL during the first 3 months and 5 to 10 ng/mL after the 3rd month; basiliximab was given on postoperative days 0 and 4. Biopsy-proven acute rejection episodes were treated by methylprednisone IV boluses. Results: After a median follow-up of 9 months (range, 1-27 months), the overall patient survival rate was 84% and graft survival rate was 79%. Three children (9%) died after their transplantations. Three (9%) experienced episodes of biopsy-proven acute rejection, always treated with IV steroid boluses. Mean RAI score was 4. One patient experienced PTLD that resolved with temporary reduction of immunosuppression. Cytomegalovirus infection rate was 14%. Sepsis occurred in 2 cases (6%). Conclusions: Initial results with a steroid-free immunosuppressive protocol are encouraging, with low rates of acute rejection and infectious complications as in steroid-based protocols.

Original languageEnglish
Pages (from-to)1099-1100
Number of pages2
JournalTransplantation Proceedings
Volume38
Issue number4
DOIs
Publication statusPublished - May 2006

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ASJC Scopus subject areas

  • Surgery
  • Transplantation

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