Steroid-free, tacrolimus-basiliximab immunosuppression in pediatric liver transplantation: clinical and pharmacoeconomic study in 50 children.
Corticosteroid-free immunosuppression (IS) may be potentially beneficial for transplanted patients, particularly children. The purpose of this study was to evaluate the efficacy and cost of such strategy in primary pediatric liver transplantation (LT). Fifty pediatric LT recipients were prospectively treated with a steroid-free, tacrolimus-basiliximab-based IS (group TB). A group of 34 children transplanted under a conventional tacrolimus-steroids regimen served as control series (group TS). Groups TB and TS were compared regarding patient and graft survival, rejection incidence, infectious complications, and growth, as well as cost of the transplant procedure. Patient and graft survivals at 3 years were 96% and 94% in group TB, versus 91% and 88% in group TS (P = 0.380 and P = 0.370, respectively). Rejection-free graft survival at 3 years was 72% in group TB, versus 41% in group TS (P = 0.007). Patients in group TB had significantly less viral infections than patients in group TS (P = 0.045). Height standard deviation score was significantly enhanced in children from group TB, when compared to group TS. Medical care costs were similar in both groups. Steroid avoidance together with basiliximab immunoprophylaxis was not harmful in terms of allograft acceptance, and even seemed to be beneficial in the long term.
Gras
Jérémie M
JM
Pediatric Liver Transplant Program, Université Catholique de Louvain, Brussels, Belgium. jeremie.gras@gmail.com
Gerkens
Sophie
S
Beguin
Claire
C
Janssen
Magdalena
M
Smets
Françoise
F
Otte
Jean-Bernard
JB
Sokal
Etienne
E
Reding
Raymond
R
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D000077552:Basiliximab; D001530:Belgium; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D007223:Infant; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000276:immunology*; D011993:Recombinant Fusion Proteins / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016559:Tacrolimus / Q000191:economics / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D011993:Recombinant Fusion Proteins; D000077552:Basiliximab; D016559:Tacrolimus