Title: Immunosuppression-free life after pediatric liver transplant: a case-control study from the Society of Pediatric Liver Transplant (SPLIT) Registry
Source: The Journal of Pediatrics 2023, Sept 17. [E-publication]
Date of publication: September 2023
Publication type: Case control study
Abstract: Objective: To compare long-term outcomes of pediatric liver transplant (LT) recipients off immunosuppression (IS) with matched controls on IS using data from the Society of Pediatric Liver Transplant (SPLIT) registry.
Study design: This was a retrospective case-control study. SPLIT participants < 18 years of age, ≥4 years post isolated LT, and off IS for ≥1 year (“cases”) were age- and sex- matched 1:2 to subjects with the same primary diagnosis and post-LT follow-up duration (“controls”). Primary outcomes included re-transplantation, allograft rejection, IS co-morbidities, and prevalence of SPLIT-derived composite “ideal outcome” (c-IO) achieved at the end of the follow-up period. Differences were compared using multiple linear regression for continuous outcomes and logistic regression for dichotomous data.
Results: The study cohort was comprised of 33 cases (42.4% male, 60.6% biliary atresia, median age at LT of 0.7 [P25, P75 0.5, 1.6] years, median IS withdrawal time of 9 [P25, P75 6, 12] years post LT) and 66 age- and sex-matched controls. No cases required re-transplantation. Cases and controls had similar growth parameters, laboratory values, calculated glomerular filtration rates, rates of post-transplant lymphoproliferative disease, graft rejection, and attainment of c-IO.
Conclusions: No differences in allograft rejection rates, IS complications, or c-IO prevalence were seen between SPLIT subjects off IS and age- and sex-matched controls remaining on IS. Discontinuation of IS most commonly occurred in the context of rigorously designed IS withdrawal trials and available sample size was small, affecting generalizability to the broader pediatric LT population.